Provider Demographics
NPI:1811092059
Name:SURGICAL CONSULTANTS OF NORTHWEST INDIANA ,P.C.
Entity type:Organization
Organization Name:SURGICAL CONSULTANTS OF NORTHWEST INDIANA ,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:BLEZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-736-6850
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-0597
Mailing Address - Country:US
Mailing Address - Phone:219-736-6850
Mailing Address - Fax:219-736-6855
Practice Address - Street 1:5521 W LINCOLN HWY
Practice Address - Street 2:SUITE 215
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-1097
Practice Address - Country:US
Practice Address - Phone:219-736-6850
Practice Address - Fax:219-736-6855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052161A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200348360Medicaid
IN200348360Medicaid
ING89813Medicare UPIN