Provider Demographics
NPI:1982637336
Name:SIGMA MEDICAL GROUP
Entity type:Organization
Organization Name:SIGMA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-449-5080
Mailing Address - Street 1:2323 FERRY ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-3054
Mailing Address - Country:US
Mailing Address - Phone:765-449-5080
Mailing Address - Fax:765-449-5086
Practice Address - Street 1:915 SAGAMORE PKWY W
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE BRA
Practice Address - State:IN
Practice Address - Zip Code:47906-1443
Practice Address - Country:US
Practice Address - Phone:765-449-5080
Practice Address - Fax:765-449-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060593207RA0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN220170BBMedicare ID - Type UnspecifiedPEDIATRICS/ADOLESCENT MED
IN141081Medicare UPIN