Provider Demographics
NPI:1922330505
Name:MEDICAL SPECIALISTS INC., PC
Entity Type:Organization
Organization Name:MEDICAL SPECIALISTS INC., PC
Other - Org Name:MEDICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-934-2461
Mailing Address - Street 1:757-45TH STREET
Mailing Address - Street 2:STE 201
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-934-2461
Mailing Address - Fax:219-934-2478
Practice Address - Street 1:919 MAIN ST
Practice Address - Street 2:STE 102
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-3717
Practice Address - Country:US
Practice Address - Phone:219-934-2492
Practice Address - Fax:219-934-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207R00000X, 207RG0300X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100157820Medicaid
IN0391060005Medicare NSC
IN499500Medicare PIN
IN0391060005Medicare PIN