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General NPI Number Information
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NPI Number | 1821360041
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Entity Type | Organization
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Legal Business Name | NWI MEDICAL GROUP LLC
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 02/13/2013
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Provider Practice Location Address
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Address Line | 5304 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-1555
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Country | US
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Telephone | 219-427-0630
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Fax | 219-427-1525
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Provider Business Mailing Address
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Address Line | 5304 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-1555
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Country | US
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Telephone | 219-427-0630
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Fax | 219-427-1525
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Authorized Official
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Title or Position | SECRETARY
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Name | FAIZUDDIN SHAREEF
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Credential | DO
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Telephone | 630-699-6846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State | IN
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