Provider Demographics
NPI: | 1659418788 |
---|---|
Name: | COMPREHENSIVE MEDICINE |
Entity Type: | Organization |
Organization Name: | COMPREHENSIVE MEDICINE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MEDICAL DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | FRANK |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MESSANA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DO |
Authorized Official - Phone: | 219-977-2090 |
Mailing Address - Street 1: | 7501 W. 15TH AVE. |
Mailing Address - Street 2: | |
Mailing Address - City: | GARY |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46406 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 219-977-2090 |
Mailing Address - Fax: | 219-977-2091 |
Practice Address - Street 1: | 7501 W 15TH AVE |
Practice Address - Street 2: | |
Practice Address - City: | GARY |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46406-2267 |
Practice Address - Country: | US |
Practice Address - Phone: | 219-977-2090 |
Practice Address - Fax: | 219-977-2091 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-30 |
Last Update Date: | 2008-02-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 02001893A | 208D00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Single Specialty |