Healthcare Provider Details

I. General information

NPI: 1265641195
Provider Name (Legal Business Name): SUNITI MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 RIDGE RD SUITE 5
MUNSTER IN
46321-1751
US

IV. Provider business mailing address

200 E 89TH AVE SUITE 2A
MERRILLVILLE IN
46410-7319
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-2000
  • Fax: 219-836-8272
Mailing address:
  • Phone: 219-736-2800
  • Fax: 219-736-6680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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