Healthcare Provider Details

I. General information

NPI: 1134252240
Provider Name (Legal Business Name): ORTHOPAEDIC ASSOCIATES OF HAMMOND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9034 COLUMBIA AVE
MUNSTER IN
46321-2905
US

IV. Provider business mailing address

9034 COLUMBIA AVE
MUNSTER IN
46321-2905
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-0296
  • Fax: 219-836-0570
Mailing address:
  • Phone: 219-836-0296
  • Fax: 219-836-0570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. BERNARD J BURCZYK JR.
Title or Position: EXECUTIVE ADMINISTRATOR
Credential:
Phone: 219-836-0296