MEDICARE: NORTHWOOD PHYSICIANS, INC.

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	207Q00000X	Family Medicine Physician	50001361A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851571236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWOOD PHYSICIANS, INC.

Provider Business Mailing Address
First Line	:	1001 N MAIN ST
Second Line	:	SUITE ONE
City	:	NAPPANEE
State	:	IN
Zip	:	46550-1038
Country	:	US
Telephone Number	:	574-773-4151
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 N MAIN ST
Second Line	:	SUITE ONE
City	:	NAPPANEE
State	:	IN
Zip	:	46550-1038
Country	:	US
Telephone Number	:	574-773-4151
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL H. I. BORGER
Credential	:	D.O.
Telephone Number	:	574-773-4151

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	11/14/2007

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