Healthcare Provider Details

I. General information

NPI: 1285643205
Provider Name (Legal Business Name): DWIGHT S TYNDALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 12/20/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E 109TH AVE
CROWN POINT IN
46307-7294
US

IV. Provider business mailing address

601 GATEWAY AVE
CHESTERTON IN
46304
US

V. Phone/Fax

Practice location:
  • Phone: 219-921-1444
  • Fax:
Mailing address:
  • Phone: 219-921-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01051714A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number01051714A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: