Healthcare Provider Details

I. General information

NPI: 1538158134
Provider Name (Legal Business Name): JAY TIMOTHY AMES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 E PORTER AVE STE 5
CHESTERTON IN
46304-9111
US

IV. Provider business mailing address

951 TRANSPORT DR
VALPARAISO IN
46383-8434
US

V. Phone/Fax

Practice location:
  • Phone: 219-767-4858
  • Fax: 219-406-8129
Mailing address:
  • Phone: 219-462-7173
  • Fax: 219-465-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01035822
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: