Provider Demographics
NPI:1639384001
Name:WARSAW MEDICAL GROUP
Entity Type:Organization
Organization Name:WARSAW MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KISHAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:KISHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-269-3420
Mailing Address - Street 1:2219 DUBOIS DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3212
Mailing Address - Country:US
Mailing Address - Phone:574-269-3420
Mailing Address - Fax:574-269-2234
Practice Address - Street 1:2219 DUBOIS DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3212
Practice Address - Country:US
Practice Address - Phone:574-269-3420
Practice Address - Fax:574-269-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034706A208000000X
IN01036480208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN459310Medicare PIN