Healthcare Provider Details

I. General information

NPI: 1669659942
Provider Name (Legal Business Name): PITHADIA MEDICAL PROFESSIONAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 LEONARD DR
VALPARAISO IN
46383-7136
US

IV. Provider business mailing address

2801 LEONARD DR
VALPARAISO IN
46383-7136
US

V. Phone/Fax

Practice location:
  • Phone: 219-476-1704
  • Fax:
Mailing address:
  • Phone: 219-476-1704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01033172A
License Number StateIN

VIII. Authorized Official

Name: BHARAT K PITHADIA
Title or Position: PRESIDETN
Credential: MD
Phone: 219-476-1703