Provider Demographics
NPI:1750697348
Name:MUNSTER MEDICAL RESEARCH FOUNDATION INC
Entity type:Organization
Organization Name:MUNSTER MEDICAL RESEARCH FOUNDATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:FESKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-836-1600
Mailing Address - Street 1:901 MACARTHUR BOULEVARD
Mailing Address - Street 2:ATTN ANESTHESIA
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2901
Mailing Address - Country:US
Mailing Address - Phone:219-836-7040
Mailing Address - Fax:219-513-1127
Practice Address - Street 1:4321 FIR STREET
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312
Practice Address - Country:US
Practice Address - Phone:219-392-1700
Practice Address - Fax:219-513-1127
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNSTER MEDICAL RESEARCH FOUNDATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-20
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200261490BMedicaid
000000100902OtherANTHEM BCBS
IL90000960OtherBCBS ILLINOIS
INCE8881OtherMEDICARE RAILROAD
000000100902OtherANTHEM BCBS