Healthcare Provider Details

I. General information

NPI: 1023321684
Provider Name (Legal Business Name): INDIANA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 E LINCOLNWAY
VALPARAISO IN
46383-5483
US

IV. Provider business mailing address

407 E LINCOLNWAY
VALPARAISO IN
46383-5483
US

V. Phone/Fax

Practice location:
  • Phone: 888-339-7339
  • Fax:
Mailing address:
  • Phone: 888-339-7339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: KINJOT SINGH
Title or Position: CEO - PRESIDENT
Credential: MD
Phone: 888-339-7339