Provider Demographics
NPI:1154311751
Name:NIDEA, LUIS ALVAREZ (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALVAREZ
Last Name:NIDEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:574-647-1840
Mailing Address - Fax:
Practice Address - Street 1:100 NAVARRE PL STE 4400
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1100
Practice Address - Country:US
Practice Address - Phone:574-544-5580
Practice Address - Fax:574-544-5579
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058943A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200478990Medicaid
IN146470A1Medicare ID - Type Unspecified
IN200478990Medicaid