Healthcare Provider Details

I. General information

NPI: 1609340983
Provider Name (Legal Business Name): NWI BEHAVIORAL & ADDICTION MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2019
Last Update Date: 01/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7805 TAFT ST
MERRILLVILLE IN
46410-5233
US

IV. Provider business mailing address

7805 TAFT ST
MERRILLVILLE IN
46410-5233
US

V. Phone/Fax

Practice location:
  • Phone: 219-841-7141
  • Fax: 773-570-9682
Mailing address:
  • Phone: 219-841-7141
  • Fax: 773-570-9682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM ZATO
Title or Position: OWNER
Credential: MD
Phone: 219-841-7141