Provider Demographics
NPI:1104985464
Name:MICHIANA HOSPITALIST LLC
Entity type:Organization
Organization Name:MICHIANA HOSPITALIST LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRETOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAMOON
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-243-4875
Mailing Address - Street 1:51265 AMESBURRY WAY
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4828
Mailing Address - Country:US
Mailing Address - Phone:574-243-4875
Mailing Address - Fax:574-243-4847
Practice Address - Street 1:51265 AMESBURRY WAY
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-4828
Practice Address - Country:US
Practice Address - Phone:574-243-4875
Practice Address - Fax:574-243-4847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherTAX ID