Provider Demographics
NPI:1568413177
Name:WINFIELD FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:WINFIELD FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBUS
Authorized Official - Suffix:
Authorized Official - Credentials:DO, FACOFP
Authorized Official - Phone:219-226-1529
Mailing Address - Street 1:9150 E 109TH AVE
Mailing Address - Street 2:STE 2A
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7686
Mailing Address - Country:US
Mailing Address - Phone:219-226-1529
Mailing Address - Fax:219-226-2994
Practice Address - Street 1:9150 E 109TH AVE STE 2A
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7686
Practice Address - Country:US
Practice Address - Phone:219-226-1529
Practice Address - Fax:219-226-2994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty