Provider Demographics
NPI:1124166038
Name:THE GOOD DOCTOR, P.C.
Entity type:Organization
Organization Name:THE GOOD DOCTOR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:W
Authorized Official - Last Name:STOVALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-365-5405
Mailing Address - Street 1:8126 PULASKI ST
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2531
Mailing Address - Country:US
Mailing Address - Phone:219-365-5405
Mailing Address - Fax:
Practice Address - Street 1:952 S COURT ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4848
Practice Address - Country:US
Practice Address - Phone:219-226-0650
Practice Address - Fax:219-226-0618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001581A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100464880BMedicaid
IN162530Medicare PIN