Healthcare Provider Details

I. General information

NPI: 1598709685
Provider Name (Legal Business Name): DUNELAND NEPHROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 VILLAGE POINT SUITE 102
CHESTERTON IN
46304-9689
US

IV. Provider business mailing address

3100 VILLAGE PT SUITE 102
CHESTERTON IN
46304-9689
US

V. Phone/Fax

Practice location:
  • Phone: 219-395-1046
  • Fax: 219-395-1570
Mailing address:
  • Phone: 219-395-1046
  • Fax: 219-395-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JUDY MASON
Title or Position: PROJECT MANAGER
Credential:
Phone: 219-531-2675