Provider Demographics
NPI:1336843051
Name:NOAH'S ARK PEDIATRICS LLC
Entity Type:Organization
Organization Name:NOAH'S ARK PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DIMITROFF
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:219-462-4655
Mailing Address - Street 1:1610 CALUMET AVE STE B
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-3328
Mailing Address - Country:US
Mailing Address - Phone:219-462-4655
Mailing Address - Fax:219-462-2491
Practice Address - Street 1:1610 CALUMET AVE STE B
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3328
Practice Address - Country:US
Practice Address - Phone:219-462-4655
Practice Address - Fax:219-462-2491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty