MEDICARE: DSI DUNELAND DIALYSIS-MICHIGAN CITY LLC

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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1528421344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DSI DUNELAND DIALYSIS-MICHIGAN CITY LLC

Provider Business Mailing Address
First Line	:	5851 LEGACY CIR
Second Line	:	SUITE 900
City	:	PLANO
State	:	TX
Zip	:	75024-5966
Country	:	US
Telephone Number	:	214-736-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3727 FRONTAGE RD
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-7694
Country	:	US
Telephone Number	:	219-879-9450
Fax Number	:

Authorized Official
Title or Position	:	GENERAL COUNSEL
Name	:	THOMAS WEINBERG
Credential	:
Telephone Number	:	214-736-2730

Provider Enumeration Date	:	03/30/2016
Last Update Date	:	11/23/2016

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