Provider Demographics
NPI:1952587776
Name:GAMA PC INC
Entity Type:Organization
Organization Name:GAMA PC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:YESSENOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-513-1300
Mailing Address - Street 1:9250 COLUMBIA AVE
Mailing Address - Street 2:STE 2A
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-513-1300
Mailing Address - Fax:219-513-2385
Practice Address - Street 1:9250 COLUMBIA AVE
Practice Address - Street 2:STE 2A
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-513-1300
Practice Address - Fax:219-513-2385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030811A207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN00000048616OtherANTHEM
IN00000048616OtherANTHEM