Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Icp PPO, LLC

Organization Specialist · NPI 1407443617

Icp PPO, LLC is a Specialist in South Bend, Indiana. Registered with an NPI since 2020.

In the registry since
2020
Specialties on file
2
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

211 N Eddy St
South Bend, IN 46617-2808
Phone: (574) 234-8161
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Preferred Provider Organization (primary) Taxonomy 305R00000X
Specialist Taxonomy 174400000X

Record details

NPI number1407443617
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kelly Macken - Marble — President · (218) 393-1566
NPI enumeratedDecember 22, 2020
Last updated in NPPESDecember 22, 2020
Certification dateDecember 22, 2020
Mailing address413 W Montgomery Xrd Ste 602, Savannah, GA 31406-3396

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