Provider Demographics
NPI:1922183995
Name:LAPORTE PEDIATRICS PC
Entity Type:Organization
Organization Name:LAPORTE PEDIATRICS PC
Other - Org Name:CHILDREN'S CLINIC MUNSTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GAEKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-836-1855
Mailing Address - Street 1:9337 CALUMET AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-5805
Mailing Address - Country:US
Mailing Address - Phone:219-836-1855
Mailing Address - Fax:219-835-0527
Practice Address - Street 1:9337 CALUMET AVE STE A
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-5805
Practice Address - Country:US
Practice Address - Phone:219-836-1855
Practice Address - Fax:219-836-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200432120Medicaid
IN200432120Medicaid