Allied Physicians of Michiana, LLC

Organization Active NPI Vascular Surgery Physician · Mishawaka, IN

NPI 1154832178 · NPPES record last updated Jun 16, 2018

Key facts

NPI
1154832178
Entity type
Organization (NPI type 2)
Primary specialty
Vascular Surgery Physician 2086S0129X
Legal business name
ALLIED PHYSICIANS OF MICHIANA, LLC
Practice address
611 E Douglas Rd Ste 308
Mishawaka, IN 46545-1465
Phone
(574) 236-1888
NPI assigned
Oct 17, 2017
Organization subpart
Yes
Parent organization (as reported)
ALLIED PHYSICIANS OF MICHIANA, LLC

Authorized official

Name
Shery Roussarie
Title
Ceo
Phone
(574) 251-2100

Corporate family (same tax ID) 3

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Allied Physicians of Michiana LLC (4 organizations share this tax ID)
Part of
Allied Physicians of Michiana LLC

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician
Group: 193400000X SINGLE SPECIALTY GROUP
2086S0129X Yes

Addresses

Primary practice location

611 E Douglas Rd Ste 308
Mishawaka, IN 46545-1465

Mailing address

6301 University Commons Ste 230
South Bend, IN 46635-1590

Other names

  • Northern Indiana Vascualr Institute Doing business as
  • Northern Indiana Vascular Institute Doing business as

Other providers in Mishawaka, IN

All providers in Mishawaka, IN · Vascular Surgery Physician in Indiana

Sources for this page

Verify at the official NPI Registry.