Healthcare Provider Details

I. General information

NPI: 1700927811
Provider Name (Legal Business Name): ARTHRITIS CARE OF MICHIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NAVARRE PL STE 5570
SOUTH BEND IN
46601-1169
US

IV. Provider business mailing address

2813 S TWYCKENHAM DR
SOUTH BEND IN
46614-1443
US

V. Phone/Fax

Practice location:
  • Phone: 574-246-9161
  • Fax:
Mailing address:
  • Phone: 574-246-9161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number01039340A
License Number StateIN

VIII. Authorized Official

Name: ALAN J BIRNBAUM
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 574-233-6620