Provider Demographics
NPI:1598709685
Name:DUNELAND NEPHROLOGY PC
Entity Type:Organization
Organization Name:DUNELAND NEPHROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-531-2675
Mailing Address - Street 1:3100 VILLAGE PT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-9689
Mailing Address - Country:US
Mailing Address - Phone:219-395-1046
Mailing Address - Fax:219-395-1570
Practice Address - Street 1:3100 VILLAGE POINT
Practice Address - Street 2:SUITE 102
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-9689
Practice Address - Country:US
Practice Address - Phone:219-395-1046
Practice Address - Fax:219-395-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1788579OtherCIGNA
IN200825410Medicaid
000000485800OtherBC/BS
0007014704OtherAETNA
DF2542OtherRAILROAD MEDICARE