Provider Demographics
NPI:1285991885
Name:NORTHWEST INDIANA NEPHROLOGY PC
Entity type:Organization
Organization Name:NORTHWEST INDIANA NEPHROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AJ
Authorized Official - Middle Name:
Authorized Official - Last Name:PAMPALONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-836-2022
Mailing Address - Street 1:2711 LEONARD DR STE 101
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-7121
Mailing Address - Country:US
Mailing Address - Phone:219-462-6001
Mailing Address - Fax:219-462-6060
Practice Address - Street 1:2711 LEONARD DR STE 101
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-7121
Practice Address - Country:US
Practice Address - Phone:219-462-6001
Practice Address - Fax:219-462-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201062390Medicaid
INM100068764Medicare PIN