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NPI Code Detail

MEDICARE: RADIOLOGIC ASSOCIATES OF NORTHWEST INDIANA, PC

MEDICARE: RADIOLOGIC ASSOCIATES OF NORTHWEST INDIANA, PC
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
12085R0202XDiagnostic Radiology Physician50000061AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CBO346OTHERINRR MEDICARE
3655660OTHERMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235186867
Entity Type Code : Organization
Provider Name (Legal Business Name) : RADIOLOGIC ASSOCIATES OF NORTHWEST INDIANA, PC
Provider Business Mailing Address
First Line : 85 E US HIGHWAY 6
Second Line :
City : VALPARAISO
State : IN
Zip : 46383-8947
Country : US
Telephone Number : 219-464-4891
Fax Number : 219-464-1873
Provider Business Practice Location Address
First Line : 85 E US HIGHWAY 6
Second Line :
City : VALPARAISO
State : IN
Zip : 46383-8947
Country : US
Telephone Number : 219-464-4891
Fax Number : 219-464-1873
Authorized Official
Title or Position : PRACTICE MANAGER
Name : KATHLEEN M ODUM
Credential : R.T.
Telephone Number : 219-464-4891
Provider Enumeration Date : 05/28/2006
Last Update Date : 02/19/2015

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Directions to “RADIOLOGIC ASSOCIATES OF NORTHWEST INDIANA, PC ” Practice Location

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