| Michiana Internal Medicine Pc | |
|
525 W Bristol St Elkhart IN 46514-2964 | |
| (574) 295-5900 | |
| (574) 295-5922 |
| Full Name | Michiana Internal Medicine Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 525 W Bristol St, Elkhart, Indiana |
| Authorized Official Name and Position | Israr Azim Siddiqi (PRESIDENT) |
| Authorized Official Contact | 5742955900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michiana Internal Medicine Pc 525 W Bristol St Elkhart IN 46514-2964 Ph: (574) 295-5900 | Michiana Internal Medicine Pc 525 W Bristol St Elkhart IN 46514-2964 Ph: (574) 295-5900 |
| NPI Number | 1467571570 |
|---|---|
| Provider Enumeration Date | 03/28/2007 |
| Last Update Date | 01/09/2018 |
| Medicare PECOS PAC ID | 2466543491 |
|---|---|
| Medicare Enrollment ID | O20070806000700 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467571570 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 50004928A (Indiana) | Primary |
| Provider Name | Israr A Siddiqi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346289501 PECOS PAC ID: 6406834522 Enrollment ID: I20040713001276 |
| Provider Name | Beth Ann Lockwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306297858 PECOS PAC ID: 3779865423 Enrollment ID: I20180404000265 |
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