Healthcare Provider Details

I. General information

NPI: 1578384772
Provider Name (Legal Business Name): ORTHOPEDIC MEDICAL DEVELOPMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 08/01/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E 101ST AVENUE
CROWN POINT IN
46307-8001
US

IV. Provider business mailing address

201 E 101ST AVENUE
CROWN POINT IN
46307
US

V. Phone/Fax

Practice location:
  • Phone: 219-661-6018
  • Fax: 219-703-6623
Mailing address:
  • Phone: 219-661-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CHAR KULLERSTRAND
Title or Position: DIRECTOR PFS
Credential:
Phone: 219-934-8994