Provider Demographics
NPI:1700193208
Name:HOBART CLINIC LLC
Entity Type:Organization
Organization Name:HOBART CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOLATOWSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:219-945-5888
Mailing Address - Street 1:1441 S LAKE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6635
Mailing Address - Country:US
Mailing Address - Phone:219-945-5888
Mailing Address - Fax:219-945-5880
Practice Address - Street 1:1441 S LAKE PARK AVE
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6635
Practice Address - Country:US
Practice Address - Phone:219-945-5888
Practice Address - Fax:219-945-5880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046155A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
209440Medicare PIN
C43862Medicare UPIN