Provider Demographics
NPI:1538432141
Name:C & D HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:C & D HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:UDODILI
Authorized Official - Last Name:ILO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-420-2800
Mailing Address - Street 1:327 E WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-2753
Mailing Address - Country:US
Mailing Address - Phone:260-420-2800
Mailing Address - Fax:260-846-5815
Practice Address - Street 1:327 E WAYNE ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-2753
Practice Address - Country:US
Practice Address - Phone:260-420-2800
Practice Address - Fax:260-846-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.097123207R00000X
IN01064700A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty