Organization
NORTHERN INDIANA DERMATOLOGY AND SKIN SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUCHIK S DESAI (PHYSICIAN)
(219) 764-3600
Entity
Organization
Contact information
Practice address
3190 LANCER ST, PORTAGE, IN 46368-4488
(219) 764-3600
(219) 764-3661
Mailing address
3190 LANCER ST, PORTAGE, IN 46368-4488
(219) 764-3600
(219) 764-3661
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
207N00000X
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000350979
ANTHEM
IN
Enumeration date
08/30/2006
Last updated
08/22/2020
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