Provider Demographics
NPI:1588678940
Name:MENDELOWITZ, DAVID SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SAMUEL
Last Name:MENDELOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1690
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46352-1690
Mailing Address - Country:US
Mailing Address - Phone:219-326-2312
Mailing Address - Fax:219-326-2584
Practice Address - Street 1:1300 STATE STREET
Practice Address - Street 2:SUITE 2C
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3134
Practice Address - Country:US
Practice Address - Phone:219-325-0152
Practice Address - Fax:219-325-8621
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01030941A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100163770Medicaid
IN100163770Medicaid