Provider Demographics
NPI:1578505814
Name:NEPHROLOGY ASSOCIATES OF NORTHERN INDIANA, PC
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES OF NORTHERN INDIANA, PC
Other - Org Name:NANI
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-974-5230
Mailing Address - Street 1:PO BOX 72362
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192-0002
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:630-368-0280
Practice Address - Street 1:855 MADISON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4420
Practice Address - Country:US
Practice Address - Phone:708-386-1000
Practice Address - Fax:708-386-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100082060Medicaid
INCA5480OtherGROUP MEDICARE RAILROAD
INCA5480Medicare PIN
INCA5480OtherGROUP MEDICARE RAILROAD
OH9277883Medicare PIN
IN628850Medicare ID - Type Unspecified
OH9277881Medicare PIN