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1578505814 NPI number — NEPHROLOGY ASSOCIATES OF NORTHERN INDIANA, INC

NPI Number: 1578505814
Health Care Provider/Practitioner: NEPHROLOGY ASSOCIATES OF NORTHERN INDIANA, INC

Information about “1578505814” NPI (NEPHROLOGY ASSOCIATES OF NORTHERN INDIANA, INC) exists in 1578505814 in HTML format HTML  |  1578505814 in plain Text format TXT  |  1578505814 in PDF (Portable Document Format) PDF  |  1578505814 in an XML format XML  formats.

NPI Number : 1578505814 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578505814",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "NEPHROLOGY ASSOCIATES OF NORTHERN INDIANA, INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "120 W 22ND ST STE 200",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OAK BROOK",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60523-1563",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "630-573-5000",
    "MailingAddressFaxNumber": "630-491-5472",
    "FirstLinePracticeLocationAddress": "11104 PARKVIEW CIRCLE DR STE 330",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT WAYNE",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46845-1674",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "260-494-3484",
    "PracticeLocationAddressFaxNumber": "260-969-0188",
    "EnumerationDate": "06/12/2006",
    "LastUpdateDate": "10/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "TANNA",
    "AuthorizedOfficialFirstName": "MANISH",
    "AuthorizedOfficialMiddleName": "M",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "630-573-5000",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207RN0300X",
        "TaxonomyName": "Nephrology Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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