Healthcare Provider Details

I. General information

NPI: 1902229784
Provider Name (Legal Business Name): VINOD NAMANA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 DON S POWERS DR
MUNSTER IN
46321-4054
US

IV. Provider business mailing address

10010 DON S POWERS DR
MUNSTER IN
46321-4054
US

V. Phone/Fax

Practice location:
  • Phone: 219-934-4200
  • Fax: 219-922-5904
Mailing address:
  • Phone: 219-934-4200
  • Fax: 219-922-5904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01080675A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number01080675A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: