Provider Demographics
NPI:1679616296
Name:INDIANA SURGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:INDIANA SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:GALOUZIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-947-1910
Mailing Address - Street 1:7895 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6665
Mailing Address - Country:US
Mailing Address - Phone:219-947-1910
Mailing Address - Fax:219-947-3117
Practice Address - Street 1:7895 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6665
Practice Address - Country:US
Practice Address - Phone:219-947-1910
Practice Address - Fax:219-947-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200059400Medicaid
IN408690Medicare ID - Type Unspecified
IN200059400Medicaid