Healthcare Provider Details

I. General information

NPI: 1114257599
Provider Name (Legal Business Name): MUNSTER ORTHOPAEDIC INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9660 WICKER AVE
SAINT JOHN IN
46373-9487
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 TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number01054586A
License Number StateIN

VIII. Authorized Official

Name: DR. JEFFREY MANUEL TIOCO
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 219-836-2225