Healthcare Provider Details

I. General information

NPI: 1518996719
Provider Name (Legal Business Name): NEPHROLOGY PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 PARK PLACE
MISHAWAKA IN
46545-3519
US

IV. Provider business mailing address

710 PARK PL STE 200
MISHAWAKA IN
46545-3519
US

V. Phone/Fax

Practice location:
  • Phone: 574-273-6767
  • Fax: 574-968-7160
Mailing address:
  • Phone: 574-273-6767
  • Fax: 574-273-6764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES PORILE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 574-273-6787