NORTHWEST INDIANA PODIATRY CLINIC, LLC; NPI #1639375058

Contact Information

NORTHWEST INDIANA PODIATRY CLINIC, LLC

1534 119TH ST
WHITING, IN 46394-1733

Phone: 219-659-0630
Fax: 219-473-0018
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Surgery, Foot & Ankle	213ES0103X	48	Podiatry
Assistant, Podiatric	211D00000X
Podiatrist	213E00000X	48	Podiatry
Primary Podiatric Medicine	213EP1101X	48	Podiatry
Public Health	213EP0504X	48	Podiatry
Radiology	213ER0200X	48	Podiatry
Sports Medicine	213ES0000X	48	Podiatry
Surgery, Foot	213ES0131X	48	Podiatry

Indicates primary specialty

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NPI Profile & details for NORTHWEST INDIANA PODIATRY CLINIC, LLC

NPI Number 1639375058

LBN Legal business name NORTHWEST INDIANA PODIATRY CLINIC, LLC

Authorized official FORTUNEE MASSUDA - (MEDICAL DIRECTOR & CEO)

Entity Organization

Organization subpart ¹ No

Enumeration date 06/22/2007

Last updated 11/12/2009 - About 17 years ago

Identifiers

IN	Medicaid	200124730B
IN	Other	90001145	BCBS

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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NORTHWEST INDIANA PODIATRY CLINIC, LLC

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NPI Profile & details for NORTHWEST INDIANA PODIATRY CLINIC, LLC

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