MEDICARE: AMERICAN MEDICAL ASSOCIATES 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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15D1025134	OTHER	IN	CLIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942303870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN MEDICAL ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	539 SAINT ANDREWS DR
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-2951
Country	:	US
Telephone Number	:	773-459-9661
Fax Number	:	219-937-2981

Provider Business Practice Location Address
First Line	:	9250 COLUMBIA AVE STE 1F
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-3530
Country	:	US
Telephone Number	:	219-937-9653
Fax Number	:	219-937-2981

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RUDYARD U SMITH
Credential	:	MD
Telephone Number	:	219-937-9653

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	03/04/2022

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