Provider Demographics
NPI:1942489307
Name:RG HALUM JR MD UROLOGY INC
Entity Type:Organization
Organization Name:RG HALUM JR MD UROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:HALUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-836-5865
Mailing Address - Street 1:800 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2917
Mailing Address - Country:US
Mailing Address - Phone:219-836-5865
Mailing Address - Fax:219-836-5499
Practice Address - Street 1:800 MACARTHUR BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2917
Practice Address - Country:US
Practice Address - Phone:219-836-5865
Practice Address - Fax:219-836-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01021652174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN495270Medicare PIN