Provider Demographics
NPI:1154832178
Name:ALLIED PHYSICIANS OF MICHIANA, LLC
Entity type:Organization
Organization Name:ALLIED PHYSICIANS OF MICHIANA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSSARIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-251-2100
Mailing Address - Street 1:6301 UNIVERSITY COMMONS STE 230
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1590
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 E DOUGLAS RD STE 308
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1465
Practice Address - Country:US
Practice Address - Phone:574-236-1888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIED PHYSICIANS OF MICHIANA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty