Provider Demographics
NPI:1497954390
Name:HIGHLAND CLINIC OF NORTHWEST INDIANA INC
Entity Type:Organization
Organization Name:HIGHLAND CLINIC OF NORTHWEST INDIANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZEERULLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-838-0066
Mailing Address - Street 1:2834 HIGHWAY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-1629
Mailing Address - Country:US
Mailing Address - Phone:219-838-0066
Mailing Address - Fax:219-838-4096
Practice Address - Street 1:2834 HIGHWAY AVE STE 1
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322
Practice Address - Country:US
Practice Address - Phone:219-838-0066
Practice Address - Fax:219-838-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010226043208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
458580Medicare PIN