Healthcare Provider Details

I. General information

NPI: 1053424903
Provider Name (Legal Business Name): TEAM PHYSICIANS OF INDIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W 81ST AVE
MERRILLVILLE BRA IN
46410-5317
US

IV. Provider business mailing address

403 W 81ST AVE
MERRILLVILLE BRA IN
46410-5317
US

V. Phone/Fax

Practice location:
  • Phone: 219-756-6600
  • Fax:
Mailing address:
  • Phone: 219-756-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIN

VIII. Authorized Official

Name: DR. BENOIT O CHOINIERE
Title or Position: PRESIDENT
Credential:
Phone: 219-756-6600