Healthcare Provider Details

I. General information

NPI: 1629371117
Provider Name (Legal Business Name): PINNACLE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W 81ST AVE
MERRILLVILLE IN
46410-5317
US

IV. Provider business mailing address

1011 HERMAN ST
ELKHART IN
46516-9029
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number05008951A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002234A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number01040540A
License Number StateIN

VIII. Authorized Official

Name: MR. MICHAEL A SPITE
Title or Position: PRESIDENT
Credential:
Phone: 574-514-1785