Provider Demographics
NPI:1851507693
Name:INTERNAL MEDICINE NEPHROLOGY, INC.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE NEPHROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SISIR
Authorized Official - Middle Name:K
Authorized Official - Last Name:DHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-232-8716
Mailing Address - Street 1:1625 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-4067
Mailing Address - Country:US
Mailing Address - Phone:812-232-8716
Mailing Address - Fax:812-232-7768
Practice Address - Street 1:557 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SHELBURN
Practice Address - State:IN
Practice Address - Zip Code:47879-1232
Practice Address - Country:US
Practice Address - Phone:812-232-8716
Practice Address - Fax:812-232-7768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN855690Medicare PIN
INCM4078Medicare PIN