Provider Demographics
NPI:1295358265
Name:CULVER PEDIATRICS CENTER, INC
Entity type:Organization
Organization Name:CULVER PEDIATRICS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NOEMI
Authorized Official - Middle Name:ADAME
Authorized Official - Last Name:GAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-216-0414
Mailing Address - Street 1:16427 18TH RD
Mailing Address - Street 2:
Mailing Address - City:CULVER
Mailing Address - State:IN
Mailing Address - Zip Code:46511-9754
Mailing Address - Country:US
Mailing Address - Phone:574-216-0414
Mailing Address - Fax:586-315-2636
Practice Address - Street 1:16427 18TH RD
Practice Address - Street 2:
Practice Address - City:CULVER
Practice Address - State:IN
Practice Address - Zip Code:46511-9754
Practice Address - Country:US
Practice Address - Phone:574-216-0414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty