| Vitae Health Medical Indiana Llc | |
|
10352 N 600 E Demotte IN 46310-8959 | |
| (219) 345-5211 | |
| Not Available |
| Full Name | Vitae Health Medical Indiana Llc |
|---|---|
| Speciality | Social Worker |
| Location | 10352 N 600 E, Demotte, Indiana |
| Authorized Official Name and Position | Amish M Patel (PRESIDENT) |
| Authorized Official Contact | 8338482347 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitae Health Medical Indiana Llc 415 W Golf Rd Ste 26 Arlington Heights IL 60005-3923 Ph: (833) 848-2347 | Vitae Health Medical Indiana Llc 10352 N 600 E Demotte IN 46310-8959 Ph: (219) 345-5211 |
| NPI Number | 1396493433 |
|---|---|
| Provider Enumeration Date | 03/17/2022 |
| Last Update Date | 03/17/2022 |
| Certification Date | 03/17/2022 |
| Medicare PECOS PAC ID | 1153708086 |
|---|---|
| Medicare Enrollment ID | O20220516001732 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396493433 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| Provider Name | Timothy Scott Gobek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730487273 PECOS PAC ID: 4082932488 Enrollment ID: I20150415001444 |
| Provider Name | Zahra Shariff |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538260492 PECOS PAC ID: 8527084128 Enrollment ID: I20191028003079 |
| Provider Name | Maureen Lcsw Quinn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144641507 PECOS PAC ID: 2365876844 Enrollment ID: I20191217001868 |
| Provider Name | Dori L Grace |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609502913 PECOS PAC ID: 8224412580 Enrollment ID: I20220906001104 |
| Provider Name | Angela Trent |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922766690 PECOS PAC ID: 7012375553 Enrollment ID: I20230615001648 |
| Provider Name | Adesola Modupe Turner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619657707 PECOS PAC ID: 4880055243 Enrollment ID: I20230801003039 |
| Provider Name | Ronnie Ranjan Mandal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104002872 PECOS PAC ID: 0244303543 Enrollment ID: I20231013001036 |
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