Healthcare Provider Details

I. General information

NPI: 1619306222
Provider Name (Legal Business Name): CARDIOLOGY ASSOCIATES OF NW INDIANA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 DON POWERS DR
MUNSTER IN
46321-4054
US

IV. Provider business mailing address

10010 DON POWERS DR
MUNSTER IN
46321-4054
US

V. Phone/Fax

Practice location:
  • Phone: 219-934-4200
  • Fax: 219-934-6251
Mailing address:
  • Phone: 219-934-4200
  • Fax: 219-934-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01029887A
License Number StateIN

VIII. Authorized Official

Name: MRS. LISA A HOEFFLICKER
Title or Position: BILLING / COLLECTION MANAGER
Credential:
Phone: 219-934-4210