Provider Demographics
NPI:1063913184
Name:ENGELHARDT, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ENGELHARDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 MALLORY ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-7507
Mailing Address - Country:US
Mailing Address - Phone:219-286-5892
Mailing Address - Fax:
Practice Address - Street 1:3075 MALLORY ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-7507
Practice Address - Country:US
Practice Address - Phone:219-286-5892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate