NORTHWEST INDIANA PODIATRY CLINIC LLC NPI 1609072677

NPI Information

NPI: 1609072677
Provider Name: NORTHWEST INDIANA PODIATRY CLINIC, LLC
Classification: Podiatrist - 213ES0103X
Entity Type: Organization

Specialization: Foot & Ankle Surgery

Address:
3100 45TH AVE
HIGHLAND, IN
ZIP 46322
Phone: (219) 922-0510
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NORTHWEST INDIANA PODIATRY CLINIC, LLC is a foot and ankle surgery podiatrist in Highland, IN. NORTHWEST INDIANA PODIATRY CLINIC, LLC NPI is 1609072677. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3100 45TH AVE
HIGHLAND, IN
ZIP 46322
Phone: (219) 922-0510
Fax: (219) 923-4594

The provider's authorized official is Fortunee Massuda .
The authorized official title is Medical Director & Ceo and has the following contact phone number (773) 233-3800.

The enumeration date for this NPI number is 6/26/2007 and was last updated on 11/12/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License State	Primary
1	211D00000X	Assistant, Podiatric			No
2	213E00000X	Podiatrist		INDIANA	No
3	213EP0504X	Podiatrist	Public Medicine		No
4	213ES0131X	Podiatrist	Foot Surgery		No
5	213ER0200X	Podiatrist	Radiology		No
6	213EP1101X	Podiatrist	Primary Podiatric Medicine		No
7	213ES0103X	Podiatrist	Foot & Ankle Surgery		Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	210580	MEDICARE PIN	INDIANA
2	200124730C	MEDICAID	INDIANA
3	1609072677	MEDICARE PIN	INDIANA
4	5007670001	MEDICARE NSC	INDIANA
5	DA4713	MEDICARE PIN
6	90001145	OTHER	INDIANA	BCBS NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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