Healthcare Provider Details

I. General information

NPI: 1922018324
Provider Name (Legal Business Name): NORTHWEST INDIANA HEART CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 89TH AVE 2A
MERRILLVILLE IN
46410-7318
US

IV. Provider business mailing address

9201 CALUMET AVE
MUNSTER IN
46321-2807
US

V. Phone/Fax

Practice location:
  • Phone: 219-738-3710
  • Fax:
Mailing address:
  • Phone: 219-836-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: NEIL THOMAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 219-836-2022