Healthcare Provider Details

I. General information

NPI: 1740450766
Provider Name (Legal Business Name): JAMES N.TOPOLGUS MD SURGICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 S SARE RD
BLOOMINGTON IN
47401-4431
US

IV. Provider business mailing address

1419 S SARE RD
BLOOMINGTON IN
47401-4431
US

V. Phone/Fax

Practice location:
  • Phone: 312-388-8676
  • Fax:
Mailing address:
  • Phone: 312-388-8676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01022367
License Number StateIN

VIII. Authorized Official

Name: MS. SARA TOPOLGUS
Title or Position: DIRECTOR
Credential: JD
Phone: 312-388-8676