Michiana Internal Medicine PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

50004928A Issued in IN

Legal business name

MICHIANA INTERNAL MEDICINE PC

Practice address

525 W Bristol St
Elkhart, IN 46514-2964

Phone

(574) 295-5900

Fax

(574) 295-5922

NPI assigned

Mar 28, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Israr Azim Siddiqi, M.D.NPI 1346289501

Title

President

Phone

(574) 295-5900

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

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

• Israr Azim Siddiqi, M.D.

  • Sleep Medicine (Internal Medicine) Physician
  • Elkhart, IN
  • NPI 1346289501
  Medicare reassignment NPD Authorized official
• Victoria Gonzalez

  • Family Nurse Practitioner
  • Elkhart, IN
  • NPI 1861168460
  Medicare reassignment NPD

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515456000000",
    "number": "1467571570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 W BRISTOL ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465142964",
            "telephone_number": "574-295-5900",
            "fax_number": "574-295-5922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 W BRISTOL ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465142964",
            "telephone_number": "574-295-5900",
            "fax_number": "574-295-5922"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "625 E Bristol St Ste B",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465143476",
            "country_code": "US",
            "telephone_number": "574-295-5900",
            "fax_number": "574-295-5922",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MICHIANA INTERNAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2018-01-09",
        "status": "A",
        "authorized_official_last_name": "SIDDIQI",
        "authorized_official_first_name": "ISRAR",
        "authorized_official_middle_name": "AZIM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "574-295-5900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IN",
            "license": "50004928A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael J. Dibley, D.C., P.C.
• Michael Joseph Hartman PC
• Michelle Thomas, LCSW, LLC
• Michiana Counseling Group, LLC
• Michiana Eye Center , LLC
• Michiana Physical Medicine
• Michiana Physical Medicine
• Estrella Miguel
• Mariana Millan Montiel
• Abigale Miller

• Primary Care Clinic/Center in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Primary Care Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.