Organization
RADIOLOGIC ASSOCIATES OF NORTHWEST INDIANA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN M ODUM R.T. (PRACTICE MANAGER)
(219) 464-4891
Entity
Organization
Contact information
Practice address
85 E US HIGHWAY 6, VALPARAISO, IN 46383-8947
(219) 464-4891
(219) 464-1873
Mailing address
85 E US HIGHWAY 6, VALPARAISO, IN 46383-8947
(219) 464-4891
(219) 464-1873
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
50000061A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100225330
—
IN
01
—
655660
MEDICARE PTAN
—
01
—
CBO346
RR MEDICARE
IN
Enumeration date
05/28/2006
Last updated
02/19/2015
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