Basic Information
| Provider Information | |||||||||
| NPI: | 1528022860 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEONATOLOGY ASSOCIATES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9201 CALUMET AVE | ||||||||
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| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463212807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198362022 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 MACARTHUR BLVD | ||||||||
| Address2: | NEONATOLOGY DEPARTMENT | ||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463212901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198361600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | THAERA | ||||||||
| AuthorizedOfficialFirstName: | KONGKIET | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2198362022 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.