Provider Demographics
NPI:1952463432
Name:SOUTH LAKE WOMENS HEALTH PC
Entity Type:Organization
Organization Name:SOUTH LAKE WOMENS HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GYNECOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:RINGLAND
Authorized Official - Last Name:SEAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-663-1880
Mailing Address - Street 1:11376 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7104
Mailing Address - Country:US
Mailing Address - Phone:219-663-1880
Mailing Address - Fax:219-663-1888
Practice Address - Street 1:11376 BROADWAY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7104
Practice Address - Country:US
Practice Address - Phone:219-663-1880
Practice Address - Fax:219-663-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001265A207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF79412Medicare UPIN
IN2179630Medicare ID - Type Unspecified