Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 01038566 | IN |
N | 207RP1001X | Pulmonary Disease | 01038566 | IN |
NPI | 1033223235 |
---|---|
Provider Name | Douglas Adolph Mazurek |
First Address | Chesterton, IN 46304-8708 |
Second Address | Valparaiso, IN 46383-3767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 11/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200016720 | (05) | IN |
E75760 | (02) | IN |