Provider Demographics
NPI:1497310973
Name:219 HEALTH NETWORK INC
Entity Type:Organization
Organization Name:219 HEALTH NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:MOHAMMED
Authorized Official - Last Name:NAJAMUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-703-2585
Mailing Address - Street 1:100 W CHICAGO AVE STE F
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-3261
Mailing Address - Country:US
Mailing Address - Phone:219-703-2583
Mailing Address - Fax:219-703-6749
Practice Address - Street 1:2001 E COLUMBUS DR
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-4109
Practice Address - Country:US
Practice Address - Phone:219-398-9840
Practice Address - Fax:219-398-9845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty