| Street | 6100 U.S. Hwy 6 | ||
| City/Town | Portage | ||
| State/Province/Region | Indiana | ||
| Zip/Postal Code | 46368 | ||
| Phone Number | (219) 763-2500 | ||
| Country | United States |
| Full Name | Randi Durgan MD | ||
| Gender | male | ||
| Birthday | 1971-12-16 | ||
| Social Security Number | 502-37-4525 |
| Credit card brand | American Express | ||
| Credit card number | 374522006937594 | ||
| Expire | 2030/2 | ||
| CVV | 407 |