Provider Demographics
NPI:1851318695
Name:NORTHWEST INDIANA CARDIOVASCULAR PHYSICIANS, P.C.
Entity type:Organization
Organization Name:NORTHWEST INDIANA CARDIOVASCULAR PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:FORCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-531-9419
Mailing Address - Street 1:2000 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2800
Mailing Address - Country:US
Mailing Address - Phone:219-531-9419
Mailing Address - Fax:219-531-9655
Practice Address - Street 1:2000 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2800
Practice Address - Country:US
Practice Address - Phone:219-531-9419
Practice Address - Fax:219-531-9655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003781A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200076760Medicaid
90000561OtherBLUE SHIELD OF IL
CC2757OtherRAILROAD MEDICARE
90000561OtherBLUE SHIELD OF IL
IN200076760Medicaid