Provider Demographics
NPI:1760601389
Name:PULMONARY SPECIALISTS OF NORTHWEST INDIANA, PC
Entity Type:Organization
Organization Name:PULMONARY SPECIALISTS OF NORTHWEST INDIANA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-942-9658
Mailing Address - Street 1:7875 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:219-942-9658
Mailing Address - Fax:219-947-1996
Practice Address - Street 1:7875 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:219-942-9658
Practice Address - Fax:219-947-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100212670Medicaid
IN704270Medicare ID - Type Unspecified