Provider Demographics
NPI:1760177968
Name:STREETER MED, L.L.C.
Entity Type:Organization
Organization Name:STREETER MED, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STREETER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-791-9782
Mailing Address - Street 1:8127 MERRILLVILLE ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-1485
Mailing Address - Country:US
Mailing Address - Phone:219-791-9782
Mailing Address - Fax:219-791-9787
Practice Address - Street 1:8127 MERRILLVILLE ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-1485
Practice Address - Country:US
Practice Address - Phone:219-791-9782
Practice Address - Fax:219-791-9787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty