Healthcare Provider Details

I. General information

NPI: 1285667550
Provider Name (Legal Business Name): SUNITI MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EAST 89TH AVENUE SUITE 2A
MERRILLVILLE IN
46410-7319
US

IV. Provider business mailing address

200 EAST 89TH AVENUE SUITE 2A
MERRILLVILLE IN
46410-7319
US

V. Phone/Fax

Practice location:
  • Phone: 219-736-2800
  • Fax:
Mailing address:
  • Phone: 219-736-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIN

VIII. Authorized Official

Name: PEGGY BENDT
Title or Position: OFFICE MANAGER
Credential:
Phone: 219-736-2800