Provider Demographics
NPI:1326360256
Name:MUNSTER MEDICAL RESEARCH FOUNDATION, INC.
Entity type:Organization
Organization Name:MUNSTER MEDICAL RESEARCH FOUNDATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:FESKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-836-1600
Mailing Address - Street 1:800 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2917
Mailing Address - Country:US
Mailing Address - Phone:219-836-5512
Mailing Address - Fax:219-836-7978
Practice Address - Street 1:800 MACARTHUR BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2917
Practice Address - Country:US
Practice Address - Phone:219-836-5512
Practice Address - Fax:219-836-7978
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNSTER MEDICAL RESEARCH FOUNDATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-19
Last Update Date:2010-04-28
Deactivation Date:2010-04-13
Deactivation Code:
Reactivation Date:2010-04-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200281190Medicaid
IN200281190Medicaid