Healthcare Provider Details

I. General information

NPI: 1447195078
Provider Name (Legal Business Name): NEUROLOGICAL TESTING CENTERS OF INDIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5355 COMMERCE BLVD
CROWN POINT IN
46307-5325
US

IV. Provider business mailing address

5355 COMMERCE BLVD
CROWN POINT IN
46307-5325
US

V. Phone/Fax

Practice location:
  • Phone: 219-648-2025
  • Fax: 219-756-0608
Mailing address:
  • Phone: 219-648-2025
  • Fax: 219-756-0608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name: TIM MARLOW
Title or Position: CEO
Credential:
Phone: 219-756-0600