Provider Demographics
NPI:1497036727
Name:NORTHERN INDIANA MEDICAL CONSULTANTS PC
Entity Type:Organization
Organization Name:NORTHERN INDIANA MEDICAL CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLABODE
Authorized Official - Middle Name:E
Authorized Official - Last Name:OLADEINDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-665-7500
Mailing Address - Street 1:909 W MAUMEE ST
Mailing Address - Street 2:PO BOX 690
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-1368
Mailing Address - Country:US
Mailing Address - Phone:260-665-7500
Mailing Address - Fax:260-665-7501
Practice Address - Street 1:909 W MAUMEE ST
Practice Address - Street 2:SUITE E
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-1368
Practice Address - Country:US
Practice Address - Phone:260-665-7500
Practice Address - Fax:260-665-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046988174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty