Provider Demographics
NPI:1821343062
Name:DYNAMIC MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DYNAMIC MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:219-836-1021
Mailing Address - Street 1:8840 CALUMET AVE
Mailing Address - Street 2:SUITE#101
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2545
Mailing Address - Country:US
Mailing Address - Phone:219-836-1021
Mailing Address - Fax:219-836-5088
Practice Address - Street 1:8840 CALUMET AVE
Practice Address - Street 2:SUITE#101
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2545
Practice Address - Country:US
Practice Address - Phone:219-836-1021
Practice Address - Fax:219-836-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical