=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609340983
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NWI BEHAVIORAL & ADDICTION MEDICINE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2019
-----------------------------------------------------
Last Update Date | 01/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7805 TAFT ST
-----------------------------------------------------
City | MERRILLVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46410-5233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-841-7141
-----------------------------------------------------
Fax | 773-570-9682
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7805 TAFT ST
-----------------------------------------------------
City | MERRILLVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46410-5233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-841-7141
-----------------------------------------------------
Fax | 773-570-9682
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WILLIAM ZATO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 219-841-7141
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------