Delaine LLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

01039408A Issued in IN

Legal business name

DELAINE LLC

Practice address

1620 Country Club Rd
Suite C
Valparaiso, IN 46383-2251

Phone

(219) 464-7546

Fax

(866) 467-3763

NPI assigned

Jan 15, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Douglas J Van Putten, MD

Title

Owner/Ceo

Phone

(219) 464-7546

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Surya K Nallari, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Demotte, IN
  • NPI 1760478853
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427241600000",
    "number": "1134518053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 COUNTRY CLUB RD",
            "address_2": "SUITE C",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832251",
            "telephone_number": "219-464-7546",
            "fax_number": "866-467-3763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 COUNTRY CLUB RD",
            "address_2": "SUITE C",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832251",
            "telephone_number": "219-464-7546",
            "fax_number": "866-467-3763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELAINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-15",
        "last_updated": "2015-03-25",
        "status": "A",
        "authorized_official_last_name": "VAN PUTTEN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "219-464-7546",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "IN",
            "license": "01039408A",
            "primary": true
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "IN",
            "license": "01039408A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201275700A, B, C",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000917194",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carla Dawson, RN
• Kathleen Decorte, FNP-C
• Marie Elaine Degroate, COTA
• Joseph Joseph Dejesus, RN
• Noel Matias Del Rosario, PT
• Carrie Jane Delaney, MSW, LCSW
• Tiffany Delaney
• Laurie Marie Delvalle-Young
• Pamela Demmon
• Angela Nicole Demorotski, MSN, FNP-C

• Ophthalmology Physician in Valparaiso, IN
• Providers in Valparaiso, IN by specialty
• Ophthalmology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.