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General NPI Number Information
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NPI Number | 1851494371
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Entity Type | Organization
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Legal Business Name | NORTHWEST INDIANA SPINAL SURGERY, P.C.
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 9235 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7046
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Country | US
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Telephone | 219-738-2255
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Fax | 219-738-2060
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Provider Business Mailing Address
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Address Line | 9235 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7046
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Country | US
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Telephone | 219-738-2255
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Fax | 219-738-2060
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELIAN M SHEPHERD
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Credential | MD
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Telephone | 219-738-2255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 01033705A
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License Number State | IN
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