Provider Demographics
NPI:1508863945
Name:TOPOLGUS, JAMES NICHOLAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:NICHOLAS
Last Name:TOPOLGUS
Suffix:JR
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 1:1419 S SARE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-4431
Mailing Address - Country:US
Mailing Address - Phone:312-388-8676
Mailing Address - Fax:
Practice Address - Street 1:1419 S SARE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-4431
Practice Address - Country:US
Practice Address - Phone:312-388-8676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01022367A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN544310AOtherMEDICARE PTAN
IN544310AOtherMEDICARE PTAN
ININ2282009Medicare PIN
IN004356426OtherAETNA PIN
INE05612Medicare UPIN