Provider Demographics
NPI:1558654442
Name:KOBAK CENTER FOR GYNECOLOGY, INC.
Entity type:Organization
Organization Name:KOBAK CENTER FOR GYNECOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:KOBAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-531-7500
Mailing Address - Street 1:401 WALL ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2521
Mailing Address - Country:US
Mailing Address - Phone:219-531-7500
Mailing Address - Fax:
Practice Address - Street 1:401 WALL ST
Practice Address - Street 2:SUITE J
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2521
Practice Address - Country:US
Practice Address - Phone:219-531-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046101A207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000719406OtherANTHEM
IN201023270AMedicaid
IN201023270AMedicaid
IN000000719406OtherANTHEM