OrganizationActive
360 Integrated Medical Center, PC
NPI 1710459458 · General Practice Physician · La Porte, IN
Provider details
- NPI number
- 1710459458
- Entity type
- Organization
- Primary specialty
- General Practice PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Matthew Kirkham, Owner
Practice location
2504 Monroe St
La Porte, IN 46350-5241
Phone: (219) 326-5100
Fax: (219) 326-0180
Mailing address
2504 Monroe St
La Porte, IN 46350-5241
Registry dates
- Enumerated
- 2018-12-19
- Last updated
- 2018-12-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.