Basic Information
| Provider Information | |||||||||
| NPI: | 1922517077 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NWI FOOT AND ANKLE CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2338 DIVAC DR | ||||||||
| Address2: | |||||||||
| City: | SCHERERVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463754304 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8733 W 400 N | ||||||||
| Address2: | |||||||||
| City: | MICHIGAN CITY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463609330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193154458 | ||||||||
| FaxNumber: | 8663430937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2017 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | MINHAS | ||||||||
| AuthorizedOfficialFirstName: | HARDEEP | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8474546469 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | 03/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 016005617 | IL | N | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213E00000X | 07001228A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.