Provider Demographics
NPI:1952543175
Name:MEDICI HEALTH CARE PROVIDERS, P.C.
Entity Type:Organization
Organization Name:MEDICI HEALTH CARE PROVIDERS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:ALEXANDRE
Authorized Official - Last Name:CONSALTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-733-2273
Mailing Address - Street 1:7863 BROADWAY
Mailing Address - Street 2:SUITE219
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5553
Mailing Address - Country:US
Mailing Address - Phone:219-769-8610
Mailing Address - Fax:219-769-8625
Practice Address - Street 1:7863 BROADWAY
Practice Address - Street 2:SUITE219
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5553
Practice Address - Country:US
Practice Address - Phone:219-769-8610
Practice Address - Fax:219-769-8625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health