Provider Demographics
NPI:1760718068
Name:HEALTH DIAGNOSTICS OF NWI, LLC
Entity Type:Organization
Organization Name:HEALTH DIAGNOSTICS OF NWI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VIJAIKUMAR
Authorized Official - Middle Name:D
Authorized Official - Last Name:DHARLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-836-5799
Mailing Address - Street 1:9003A INDIANAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2502
Mailing Address - Country:US
Mailing Address - Phone:219-836-5799
Mailing Address - Fax:219-836-5399
Practice Address - Street 1:9003A INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2502
Practice Address - Country:US
Practice Address - Phone:219-836-5799
Practice Address - Fax:219-836-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory