Provider Demographics
NPI:1295934784
Name:PATRICK J. SHEETS, M.D., INC.
Entity type:Organization
Organization Name:PATRICK J. SHEETS, M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HANAAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-796-4120
Mailing Address - Street 1:9301 CONNECTICUT DRIVE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-1459
Mailing Address - Country:US
Mailing Address - Phone:219-756-2100
Mailing Address - Fax:219-756-0423
Practice Address - Street 1:9301 CONNECTICUT DRIVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307
Practice Address - Country:US
Practice Address - Phone:219-756-2100
Practice Address - Fax:219-756-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054176A207Q00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDC6351OtherRAILROAD MEDICARE
IN200502790AMedicaid
INDC6351OtherRAILROAD MEDICARE