Neil Wangstrom Md Pc

NPI 1043307978

Information of Neil Wangstrom Md Pc

The NPI 1043307978 is an Organization type. NPI No 1043307978 belongs to Neil Wangstrom Md Pc. Neil Wangstrom Md Pc specializes in Audiologist. is practising at 304 Detroit St, La Porte, Indiana 46350. You can also contact him via phone number (219) 325-3770.

Practice address located

  • 304 Detroit St
  • La Porte, Indiana 46350
  • (219) 325-3770
  • (219) 325-3770

Mailling address located

  • 304 Detroit St
  • La Porte, Indiana 46350
  • (219) 325-3770
  • (219) 325-8181
NPI No 1043307978
Primary Taxonomy
Authorized Official
Specialty of the provider
PrimaryTaxonomy CodeClassificationLicense NumberLicense State
No231H00000XAudiologist23002292AIndiana
No363L00000XNurse Practitioner71001701AIndiana
No363L00000XNurse Practitioner71001740AIndiana
Yes207Y00000XOtolaryngology01038858Indiana
Identifier for this provider
StateIdentifierTypeIssuer
IN000000105404OtherANTHEM
IN100165330Medicaidn/a
IN100165330AMedicaidn/a
IN200245050AMedicaidn/a
IN200482190Medicaidn/a
IN224040Medicare PINn/a
IN224040AMedicare PINn/a
IN224040CMedicare PINn/a
IN224040DDMedicare PINn/a
INQ60281Medicare UPINn/a
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