Healthcare Provider Details

I. General information

NPI: 1730389305
Provider Name (Legal Business Name): MUNSTER ORTHOPAEDIC INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 02/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9132 COLUMBIA AVE
MUNSTER IN
46321-2907
US

IV. Provider business mailing address

9136 COLUMBIA AVE
MUNSTER IN
46321-2907
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-2225
  • Fax: 219-836-3158
Mailing address:
  • Phone: 219-836-2225
  • Fax: 219-836-3158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY TIOCO
Title or Position: PRESIDENT
Credential: MD
Phone: 219-836-2225