Provider Demographics
NPI:1851571236
Name:NORTHWOOD PHYSICIANS, INC.
Entity Type:Organization
Organization Name:NORTHWOOD PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H I
Authorized Official - Last Name:BORGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:574-773-4151
Mailing Address - Street 1:1001 N MAIN ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:NAPPANEE
Mailing Address - State:IN
Mailing Address - Zip Code:46550-1038
Mailing Address - Country:US
Mailing Address - Phone:574-773-4151
Mailing Address - Fax:
Practice Address - Street 1:1001 N MAIN ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-1038
Practice Address - Country:US
Practice Address - Phone:574-773-4151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50001361A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100112200AMedicaid
IN224480Medicare PIN