Provider Demographics
NPI:1659516334
Name:DAVID S. MENDELOWITZ MD SURGERY PC
Entity Type:Organization
Organization Name:DAVID S. MENDELOWITZ MD SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:MENDELOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-325-0152
Mailing Address - Street 1:1300 STATE ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3134
Mailing Address - Country:US
Mailing Address - Phone:219-325-0152
Mailing Address - Fax:219-325-8621
Practice Address - Street 1:1300 STATE ST STE 2C
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030941A208600000X
IN2989246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000093837OtherANTHEM