Provider Demographics
NPI:1528249703
Name:FAMILY MEDICINE CONSULTANTS CORP
Entity type:Organization
Organization Name:FAMILY MEDICINE CONSULTANTS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANIGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-882-7730
Mailing Address - Street 1:650 GRANT STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404
Mailing Address - Country:US
Mailing Address - Phone:219-882-7730
Mailing Address - Fax:
Practice Address - Street 1:650 GRANT ST
Practice Address - Street 2:SUITE 5
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-1533
Practice Address - Country:US
Practice Address - Phone:219-882-7730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044809251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200171090BMedicaid
IN215770Medicare PIN