1174524177 NPI number — JOSEPH C LEGASPI MD

Table of content: (NPI 1174524177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174524177 NPI number — JOSEPH C LEGASPI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH C LEGASPI MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174524177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9307 CALUMET AVE
Provider Second Line Business Mailing Address:
STE D-1
Provider Business Mailing Address City Name:
MUNSTER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46321-2891
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-836-2055
Provider Business Mailing Address Fax Number:
219-836-0355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9307 CALUMET AVE
Provider Second Line Business Practice Location Address:
STE D-1
Provider Business Practice Location Address City Name:
MUNSTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46321-2891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-836-2055
Provider Business Practice Location Address Fax Number:
219-836-0355
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BUCHLER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
W
Authorized Official Title or Position:
SENIOR PRACTICE MANAGER
Authorized Official Telephone Number:
219-226-2205

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com