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NORTHWEST INDIANA PODIATRY CLINIC, LLC

Podiatric Medicine & Surgery Service Providers Assistant, Podiatric

Provider NPI: 1932305117

Organization Information:
Organization Name:  NORTHWEST INDIANA PODIATRY CLINIC, LLC
Organization is not Subpart
Authorized Official:  FORTUNEE  MASSUDA  MEDICAL DIRECTOR & CEO  773-233-3800

Practice Location:
9134 COLUMBIA AVE SUITE B MUNSTER, IN 46321-2907 US
Tel: 219-836-3112  Fax: 219-836-3109

Business Mailing Address:
9933 S WESTERN AVE SUITE 102 CHICAGO, IL 60643-1810 US
Tel: 773-233-3800  Fax: 773-233-2513

NPI Information:
NPI: 1932305117
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N211D00000XPodiatric Medicine & Surgery Service Providers
Assistant, Podiatric
N213E00000XPodiatric Medicine & Surgery Service Providers
Podiatrist
N213EP0504XPodiatric Medicine & Surgery Service Providers
Podiatrist
N213EP1101XPodiatric Medicine & Surgery Service Providers
Podiatrist
N213ER0200XPodiatric Medicine & Surgery Service Providers
Podiatrist
N213ES0000XPodiatric Medicine & Surgery Service Providers
Podiatrist
Y213ES0103XPodiatric Medicine & Surgery Service Providers
Podiatrist
N213ES0131XPodiatric Medicine & Surgery Service Providers
Podiatrist

Other Provider Identifiers:

IssuerNumberStateType
BCBS90001145IN01
200124730EIN05



American Medical Association 2012 taxonomy code information

Code: 213ES0103X

Type:

Classification:



Definition:



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