Healthcare Provider Details

I. General information

NPI: 1285991885
Provider Name (Legal Business Name): NORTHWEST INDIANA NEPHROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 LEONARD DR STE 101
VALPARAISO IN
46383-7121
US

IV. Provider business mailing address

2711 LEONARD DR STE 101
VALPARAISO IN
46383-7121
US

V. Phone/Fax

Practice location:
  • Phone: 219-462-6001
  • Fax: 219-462-6060
Mailing address:
  • Phone: 219-462-6001
  • Fax: 219-462-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: AJ PAMPALONE
Title or Position: PRESIDENT
Credential: DO
Phone: 219-836-2022