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General NPI Number Information
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NPI Number | 1578505814
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Entity Type | Organization
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Legal Business Name | NEPHROLOGY ASSOCIATES OF NORTHERN INDIANA, INC
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 11104 PARKVIEW CIRCLE DR STE 330
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City | FORT WAYNE
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State | IN
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Zip | 46845-1674
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Country | US
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Telephone | 260-494-3484
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Fax | 260-969-0188
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Provider Business Mailing Address
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Address Line | 120 W 22ND ST STE 200
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City | OAK BROOK
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State | IL
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Zip | 60523-1563
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Country | US
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Telephone | 630-573-5000
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Fax | 630-491-5472
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANISH M TANNA
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Credential | MD
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Telephone | 630-573-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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