Individual
MICHAEL J NOMMENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1573 N CLINE AVE, GRIFFITH, IN 46319-1567
(219) 838-2311
Mailing address
1040 SIERRA DRIVE, SUITE 400, GREENWOOD, IN 46143-7241
(317) 528-4886
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01066790A
IN
207Q00000X
Family Medicine Physician
036-121930
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000651853
ANTHEM
IN
05
—
036121930
—
IL
05
—
200976940
—
IN
Enumeration date
07/31/2006
Last updated
03/18/2021
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