Provider Demographics
NPI:1871713578
Name:THE KOBAK CENTER FOR WOMEN'S HEALTH,INC.
Entity type:Organization
Organization Name:THE KOBAK CENTER FOR WOMEN'S HEALTH,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOBAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:219-531-7500
Mailing Address - Street 1:1101 GLENDALE BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-3767
Mailing Address - Country:US
Mailing Address - Phone:219-531-7500
Mailing Address - Fax:219-464-8823
Practice Address - Street 1:1101 GLENDALE BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3767
Practice Address - Country:US
Practice Address - Phone:219-531-7500
Practice Address - Fax:219-464-8823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200864600AMedicaid
IN200864600AMedicaid
IN253200Medicare PIN
INDO0383Medicare PIN