Provider Demographics
NPI:1093806374
Name:DIGESTIVE HEALTHCARE ASSOCIATES PC
Entity Type:Organization
Organization Name:DIGESTIVE HEALTHCARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-362-4887
Mailing Address - Street 1:8865 W 400 N #155
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360
Mailing Address - Country:US
Mailing Address - Phone:219-362-4887
Mailing Address - Fax:219-872-2712
Practice Address - Street 1:8865 W 400 N #155
Practice Address - Street 2:
Practice Address - City:MCIHGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360
Practice Address - Country:US
Practice Address - Phone:219-362-4887
Practice Address - Fax:219-872-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100209820Medicaid
IN489490Medicare ID - Type Unspecified