Healthcare Provider Details

I. General information

NPI: 1265700090
Provider Name (Legal Business Name): GREGORY GEORGE BINGAMAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 MEMORIAL DR STE 502
SOUTH BEND IN
46601-1075
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-5875
  • Fax: 574-647-5878
Mailing address:
  • Phone: 574-647-3437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704338962
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71003819A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: