Organization Name: | INDIANA MEDICAL GROUP |
NPI Number: | 1023321684 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KINJOT SINGH (CEO - PRESIDENT) |
Mailing Address: | 407 E Lincolnway Valparaiso |
State: | IN US |
Postal Code: | 463835483 |
Phone Number: | 8883397339 |
Fax Number: | |
NPI Enumeration Date: | 07/23/2010 |
NPI Last Update Date: | 07/23/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |