Provider Demographics
NPI:1912036161
Name:PHYSICIANS FOR WOMEN PC
Entity Type:Organization
Organization Name:PHYSICIANS FOR WOMEN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:WIRSING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-464-0409
Mailing Address - Street 1:880 EASTPORT CENTRE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2909
Mailing Address - Country:US
Mailing Address - Phone:219-464-0409
Mailing Address - Fax:219-464-2376
Practice Address - Street 1:880 EASTPORT CENTRE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2909
Practice Address - Country:US
Practice Address - Phone:219-464-0409
Practice Address - Fax:219-464-2376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50004100A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100189860AMedicaid
IN50004100AOtherMEDICAL CORPORATION
IN100189860AMedicaid