Provider Demographics
NPI:1285643205
Name:TYNDALL, DWIGHT S (MD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:S
Last Name:TYNDALL
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 1:601 GATEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304
Mailing Address - Country:US
Mailing Address - Phone:219-921-1444
Mailing Address - Fax:
Practice Address - Street 1:759 45TH ST
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2938
Practice Address - Country:US
Practice Address - Phone:219-921-1444
Practice Address - Fax:219-921-5303
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051714A207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200226250AMedicaid
140220OtherMEDICARE GROUP SMMN
90000692OtherBCIL GROUP
001051714OtherBCIL TYNDALL
IN104771OtherANTHEM GROUP
5797564OtherAETNA
CI3318OtherRRMEDICARE GROUP
IL036095677Medicaid
1160572OtherFIRST HEALTH
200135850AOtherMEDICAID IND GROUP
00000092093OtherANTHEM
IN874640OtherMEDICARE GROUP
IN874640EMedicare PIN
INF84214Medicare UPIN
90000692OtherBCIL GROUP
IN874640OtherMEDICARE GROUP
IL036095677Medicaid