Lake Park Clinic, P.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LAKE PARK CLINIC, P.C.

Practice address

1356 S Lake Park Ave
Hobart, IN 46342-5964

Phone

(219) 942-8518

Fax

(219) 947-2751

NPI assigned

Jun 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christine Jordan

Title

Office Manager

Phone

(219) 942-1422

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402617600000",
    "number": "1083810253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1356 S LAKE PARK AVE",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463425964",
            "telephone_number": "219-942-8518",
            "fax_number": "219-947-2751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1356 S LAKE PARK AVE",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463425964",
            "telephone_number": "219-942-8518",
            "fax_number": "219-947-2751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE PARK CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-25",
        "last_updated": "2014-06-13",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "219-942-1422"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000086604",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000550461",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100159850A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maureen Kozlow, PA-C
• Mary P Kustron
• Fadee Kutom, MD
• Labcorp Indiana Inc
• Laboratory Corporation of America Holdings
• Lake Park Dental Group
• Lake Park Surgicare, LLC
• Lakeshore Anesthesia, P.C.
• Mariah Landeros, RBT
• Mary Latham

• Family Medicine Physician in Hobart, IN
• Providers in Hobart, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.