Provider Demographics
NPI:1528397478
Name:MUNSTER ORTHOPAEDIC INSTITUTE
Entity Type:Organization
Organization Name:MUNSTER ORTHOPAEDIC INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:TIOCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-399-3896
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-0609
Mailing Address - Country:US
Mailing Address - Phone:219-677-4940
Mailing Address - Fax:219-865-2143
Practice Address - Street 1:801 MACARTHUR BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2915
Practice Address - Country:US
Practice Address - Phone:219-677-4940
Practice Address - Fax:219-865-2143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054586A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN254190Medicare UPIN