Healthcare Provider Details

I. General information

NPI: 1477553634
Provider Name (Legal Business Name): LA PORTE COUNTY ANESTHESIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 FRANCISCAN WAY
MICHIGAN CITY IN
46360-0033
US

IV. Provider business mailing address

1507 WABASH ST SUITE 400C
MICHIGAN CITY IN
46360-4300
US

V. Phone/Fax

Practice location:
  • Phone: 192-877-1033
  • Fax: 178-856-0655
Mailing address:
  • Phone: 219-871-0833
  • Fax: 219-871-0836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMIL AHMED
Title or Position: OWNER
Credential: M.D.
Phone: 219-877-7947