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NPI Code Detail

MEDICARE: DR. JYOTSHAL GHIMIRE DO

MEDICARE: DR. JYOTSHAL GHIMIRE DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207R00000XInternal Medicine Physician02008928AIN

General Provider Information

NPI Number : 1083316814
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JYOTSHAL GHIMIRE DO
Provider Business Mailing Address
First Line : 1610 DELOS MARR AVE
Second Line :
City : CHESTERTON
State : IN
Zip : 46304-4504
Country : US
Telephone Number : 219-902-4538
Fax Number :
Provider Business Practice Location Address
First Line : 7950 W JEFFERSON BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-4160
Country : US
Telephone Number : 260-435-7001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2023
Last Update Date : 06/17/2026

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