Healthcare Provider Details

I. General information

NPI: 1154236016
Provider Name (Legal Business Name): NWI HOME DOCTOR AND PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3847 EUCLID AVE
EAST CHICAGO IN
46312-2332
US

IV. Provider business mailing address

2054 RICHARD GORDON HATCHER BLVD
GARY IN
46404-3060
US

V. Phone/Fax

Practice location:
  • Phone: 219-398-0700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ADAM MLYNARCIK
Title or Position: BILLING MANAGER
Credential:
Phone: 219-769-1670