=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598709685
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUNELAND NEPHROLOGY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2006
-----------------------------------------------------
Last Update Date | 04/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3100 VILLAGE POINT SUITE 102
-----------------------------------------------------
City | CHESTERTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46304-9689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-395-1046
-----------------------------------------------------
Fax | 219-395-1570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3100 VILLAGE PT SUITE 102
-----------------------------------------------------
City | CHESTERTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46304-9689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-395-1046
-----------------------------------------------------
Fax | 219-395-1570
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROJECT MANAGER
-----------------------------------------------------
Name | JUDY MASON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 219-531-2675
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------