Healthcare Provider Details

I. General information

NPI: 1982637336
Provider Name (Legal Business Name): SIGMA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 SAGAMORE PKWY W
WEST LAFAYETTE BRA IN
47906-1443
US

IV. Provider business mailing address

2323 FERRY ST SUITE 104
LAFAYETTE IN
47904-3054
US

V. Phone/Fax

Practice location:
  • Phone: 765-449-5080
  • Fax: 765-449-5086
Mailing address:
  • Phone: 765-449-5080
  • Fax: 765-449-5086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01060593
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number01060593
License Number StateIN

VIII. Authorized Official

Name: JOYCE MINICK
Title or Position: PHYSICIAN PRACTICE MANAGER
Credential:
Phone: 765-449-5080