MEDICARE: DUNELAND NEPHROLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	DF2542	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1788579	OTHER	CIGNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000485800	OTHER	BC/BS
4	0007014704	OTHER	AETNA

General Provider Information

NPI Number	:	1598709685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUNELAND NEPHROLOGY PC

Provider Business Mailing Address
First Line	:	3100 VILLAGE PT
Second Line	:	SUITE 102
City	:	CHESTERTON
State	:	IN
Zip	:	46304-9689
Country	:	US
Telephone Number	:	219-395-1046
Fax Number	:	219-395-1570

Provider Business Practice Location Address
First Line	:	3100 VILLAGE POINT
Second Line	:	SUITE 102
City	:	CHESTERTON
State	:	IN
Zip	:	46304-9689
Country	:	US
Telephone Number	:	219-395-1046
Fax Number	:	219-395-1570

Authorized Official
Title or Position	:	PROJECT MANAGER
Name	:	JUDY MASON
Credential	:
Telephone Number	:	219-531-2675

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	04/22/2021

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Directions to “DUNELAND NEPHROLOGY PC ” Practice Location

Language	Start Address	Practice Location

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