Healthcare Provider Details

I. General information

NPI: 1437256146
Provider Name (Legal Business Name): PEDIATRIX MEDICAL GROUP OF INDIANA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N MICHIGAN ST
SOUTH BEND IN
46601-1033
US

IV. Provider business mailing address

1301 CONCORD TER STE 300
SUNRISE FL
33323-2843
US

V. Phone/Fax

Practice location:
  • Phone: 574-234-2287
  • Fax: 574-234-5803
Mailing address:
  • Phone: 800-243-3839
  • Fax: 804-253-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN M PITZER
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 800-243-3839