Bautista, Teofilo S

Bautista, Teofilo S is an individual health care provider with primary practice located at 642 S Lake St , Gary IN 46403-2967. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Bautista, Teofilo S can be contacted via phone (219) 938-4481.

Contact Information

Primary practice address
642 S Lake St Gary IN 46403-2967
Phone: (219) 938-4481
Fax: (219) 938-6480
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01032450 Indiana

Profile Details

NPI number 1801894076
LBN Legal business name Bautista, Teofilo S
Credentials M.D., P.C.
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2005
Last updated Jan 29th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801894076 NPPES
Indiana MEDICAID 100169010A

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