Organization
NORTHWEST INDIANA PODIATRY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FORTUNEE MASSUDA DPM (MEDICAL DIRECTOR & CEO)
(773) 233-3800
Entity
Organization
Contact information
Practice address
1534 119TH ST, WHITING, IN 46394-1733
(219) 659-0630
(219) 473-0018
Mailing address
9933 S WESTERN AVE, SUITE 102, CHICAGO, IL 60643-1810
(773) 233-3800
(773) 233-2513
Taxonomy
Speciality
Code
Description
License number
State
211D00000X
Podiatric Assistant
—
—
213E00000X
Podiatrist
—
—
213EP0504X
Public Medicine Podiatrist
—
—
213EP1101X
Primary Podiatric Medicine Podiatrist
—
—
213ER0200X
Radiology Podiatrist
—
—
213ES0000X
Sports Medicine Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
213ES0131X
Foot Surgery Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200124730B
—
IN
01
—
90001145
BCBS
IN
Enumeration date
06/22/2007
Last updated
11/12/2009
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