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NORTHERN INDIANA DERMATOLOGY AND SKIN SURGERY CENTER NPI 1639289093


NPI Information

NPI: 1639289093
Provider Name: NORTHERN INDIANA DERMATOLOGY AND SKIN SURGERY CENTER
Classification: Dermatology - 207ND0101X
Entity Type: Organization

Specialization: MOHS-Micrographic Surgery

Address:
3190 LANCER ST
PORTAGE, IN
ZIP 46368
Phone: (219) 764-3600
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NORTHERN INDIANA DERMATOLOGY AND SKIN SURGERY CENTER is a mohs-micrographic surgery dermatology in Portage, IN. The provider is the highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. NORTHERN INDIANA DERMATOLOGY AND SKIN SURGERY CENTER NPI is 1639289093. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3190 LANCER ST
PORTAGE, IN
ZIP 46368-488
Phone: (219) 764-3600
Fax: (219) 764-3661

The provider's authorized official is Ruchik S Desai .
The authorized official title is Physician and has the following contact phone number (219) 764-3600.

The enumeration date for this NPI number is 8/30/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207ND0101XDermatologyMOHS-Micrographic Surgery207N00000XINDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1000000350979OTHERINDIANAANTHEM

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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