Provider Demographics
NPI:1528137205
Name:9128 COLUMBIA CORPORATION
Entity type:Organization
Organization Name:9128 COLUMBIA CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AZRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHERIFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-836-2730
Mailing Address - Street 1:9128 COLUMBIA CORPORATION
Mailing Address - Street 2:9128 COLUMBIA AVENUE
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-836-2730
Mailing Address - Fax:219-836-0244
Practice Address - Street 1:9128 COLUMBIA CORPORATION
Practice Address - Street 2:9128 COLUMBIA AVENUE
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-836-2730
Practice Address - Fax:219-836-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0632560208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty