# NORTHWEST INDIANA PODIATRY CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609072677
- **Authorized official:** DR. FORTUNEE MASSUDA DPM (MEDICAL DIRECTOR & CEO)
- **Authorized official phone:** (773) 233-3800

## Contact information

- **Practice address:** 3100 45TH AVE, HIGHLAND, IN 46322
- **Practice address phone:** (219) 922-0510
- **Practice address fax:** (219) 923-4594
- **Mailing address:** 9933 S WESTERN AVE, SUITE 102, CHICAGO, IL 60643-1810
- **Mailing address phone:** (773) 445-3800
- **Mailing address fax:** (773) 233-2513

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 211D00000X | Podiatric Assistant | — | NULL | — |
| 211D00000X | Podiatric Assistant | — | — | — |
| 213E00000X | Podiatrist | — | IN | — |
| 213EP0504X | Public Medicine Podiatrist | — | NULL | — |
| 213EP0504X | Public Medicine Podiatrist | — | — | — |
| 213EP1101X | Primary Podiatric Medicine Podiatrist | — | NULL | — |
| 213EP1101X | Primary Podiatric Medicine Podiatrist | — | — | — |
| 213ER0200X | Radiology Podiatrist | — | NULL | — |
| 213ER0200X | Radiology Podiatrist | — | — | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |
| 213ES0131X | Foot Surgery Podiatrist | — | NULL | — |
| 213ES0131X | Foot Surgery Podiatrist | — | — | — |

## Other

- **Enumeration date:** 06/26/2007
- **Last updated:** 11/12/2009