Provider Demographics
NPI:1003955683
Name:THE NEUROCLINIC P C
Entity Type:Organization
Organization Name:THE NEUROCLINIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:KATARIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-878-9870
Mailing Address - Street 1:130 COMMERCE SQ
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3281
Mailing Address - Country:US
Mailing Address - Phone:219-878-9870
Mailing Address - Fax:219-878-9873
Practice Address - Street 1:130 COMMERCE SQ
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3281
Practice Address - Country:US
Practice Address - Phone:219-878-9870
Practice Address - Fax:219-878-9873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056291A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200381990Medicaid
IN200381990Medicaid