Provider Demographics
NPI:1386686145
Name:MONROE MEDICAL ASSOCIATES, SC
Entity Type:Organization
Organization Name:MONROE MEDICAL ASSOCIATES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:F
Authorized Official - Last Name:KOZLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-339-4800
Mailing Address - Street 1:801 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2915
Mailing Address - Country:US
Mailing Address - Phone:219-836-2860
Mailing Address - Fax:
Practice Address - Street 1:1600 S LAKE PARK AVE
Practice Address - Street 2:SUITE 1101
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6641
Practice Address - Country:US
Practice Address - Phone:219-947-1795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042003867207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100394430Medicaid
IN105630OtherANTHEM B S GRP PROV #
IN90001238OtherBCBS IL
IN105630OtherANTHEM B S GRP PROV #
IN4269010005Medicare NSC
IL437901Medicare ID - Type UnspecifiedMCARE GROUP PROV #
ILCA8459Medicare ID - Type UnspecifiedR R MCRE GRP PROV #
IN626820Medicare ID - Type UnspecifiedMCARE GROUP PROV #