Provider Demographics
NPI:1770660557
Name:PERSONAL HEALTH MANAGEMENT, PC
Entity Type:Organization
Organization Name:PERSONAL HEALTH MANAGEMENT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARJUN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-464-8007
Mailing Address - Street 1:2031 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2746
Mailing Address - Country:US
Mailing Address - Phone:219-464-8007
Mailing Address - Fax:219-464-7651
Practice Address - Street 1:2031 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2746
Practice Address - Country:US
Practice Address - Phone:219-464-8007
Practice Address - Fax:219-464-7651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000090548OtherANTHEM BC/BS
IN020024431OtherRR MEDICARE
IN200481530AMedicaid
IN658710Medicare PIN
IN000000090548OtherANTHEM BC/BS
INDG7688Medicare PIN