Healthcare Provider Details

I. General information

NPI: 1295030187
Provider Name (Legal Business Name): NORTHWEST INDIANA NEUROLOGICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MACARTHUR BLVD SUITE 404
MUNSTER IN
46321-2915
US

IV. Provider business mailing address

9200 CALUMET AVE SUITE N100
MUNSTER IN
46321-2885
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-2995
  • Fax: 219-836-4075
Mailing address:
  • Phone: 219-836-9100
  • Fax: 219-836-2361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology 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

VIII. Authorized Official

Name: DR. DAVID STEPHEN ROZENFELD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 219-836-2995