Organization
DERMATOLOGY ASSOCIATES OF NORTHWEST INDIANA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNE JORDAN (BUSINESS MANAGER)
(219) 302-0322
Entity
Organization
Contact information
Practice address
311 E 89TH AVE, MERRILLVILLE, IN 46410-8126
(773) 255-8873
(773) 304-1490
Mailing address
25 HARDWOOD HILL RD, PITTSFORD, NY 14534-4545
(219) 302-0322
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01057516
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200465340
—
IN
Enumeration date
03/01/2013
Last updated
12/17/2018
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