MEDICARE: SIGMA MEDICAL GROUP

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	208000000X	Pediatrics Physician	01060593	IN
2	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	01060593	IN

General Provider Information

NPI Number	:	1982637336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIGMA MEDICAL GROUP

Provider Business Mailing Address
First Line	:	2323 FERRY ST
Second Line	:	SUITE 104
City	:	LAFAYETTE
State	:	IN
Zip	:	47904-3054
Country	:	US
Telephone Number	:	765-449-5080
Fax Number	:	765-449-5086

Provider Business Practice Location Address
First Line	:	915 SAGAMORE PKWY W
Second Line	:
City	:	WEST LAFAYETTE BRA
State	:	IN
Zip	:	47906-1443
Country	:	US
Telephone Number	:	765-449-5080
Fax Number	:	765-449-5086

Authorized Official
Title or Position	:	PHYSICIAN PRACTICE MANAGER
Name	:	JOYCE MINICK
Credential	:
Telephone Number	:	765-449-5080

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	09/11/2025

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