Provider Demographics
NPI:1063460160
Name:INSTITUTE FOR ORTHOPEDIC AND NERVE SURGERY
Entity Type:Organization
Organization Name:INSTITUTE FOR ORTHOPEDIC AND NERVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:AKRE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:574-247-4667
Mailing Address - Street 1:230 E DAY RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545
Mailing Address - Country:US
Mailing Address - Phone:574-247-4667
Mailing Address - Fax:574-271-4458
Practice Address - Street 1:230 E DAY RD
Practice Address - Street 2:SUITE 130
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3408
Practice Address - Country:US
Practice Address - Phone:574-247-4667
Practice Address - Fax:574-271-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002335A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200335260AMedicaid
IN219660AMedicare ID - Type Unspecified
IN200335260AMedicaid
INH39757Medicare UPIN