Provider Demographics
NPI:1942479985
Name:PAUL NYONGANI M.D.P.C.
Entity Type:Organization
Organization Name:PAUL NYONGANI M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:NYONGANI
Authorized Official - Suffix:
Authorized Official - Credentials:MDPC
Authorized Official - Phone:219-980-1348
Mailing Address - Street 1:6111 HARRISON ST STE 252
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2971
Mailing Address - Country:US
Mailing Address - Phone:219-980-1348
Mailing Address - Fax:219-980-1151
Practice Address - Street 1:6111 HARRISON ST STE 252
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2971
Practice Address - Country:US
Practice Address - Phone:219-980-1348
Practice Address - Fax:219-980-1151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029603A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200889160AMedicaid
IN200889160AMedicaid
IN704280Medicare PIN