Northwest Indiana Podiatry Clinic, LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

NORTHWEST INDIANA PODIATRY CLINIC, LLC

Practice address

9134 Columbia Ave
Suite B
Munster, IN 46321-2907

Phone

(219) 836-3112

Fax

(219) 836-3109

NPI assigned

Jun 25, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Fortunee Massuda, DPM

Title

Medical Director & Ceo

Phone

(773) 233-3800

Specialties & licenses 8

Addresses

Other identifiers 2

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

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257984000000",
    "number": "1932305117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9933 S WESTERN AVE",
            "address_2": "SUITE 102",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606431810",
            "telephone_number": "773-233-3800",
            "fax_number": "773-233-2513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9134 COLUMBIA AVE",
            "address_2": "SUITE B",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212907",
            "telephone_number": "219-836-3112",
            "fax_number": "219-836-3109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST INDIANA PODIATRY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-25",
        "last_updated": "2009-11-12",
        "status": "A",
        "authorized_official_last_name": "MASSUDA",
        "authorized_official_first_name": "FORTUNEE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR & CEO",
        "authorized_official_telephone_number": "773-233-3800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "211D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Assistant, Podiatric",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213EP0504X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Public Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ER0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200124730E",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "90001145",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northwest Indiana Medical Associates, LLC
• Northwest Indiana Neurological Associates, PC
• Northwest Indiana Neurological Associates, PC
• Northwest Indiana Pain Services
• Northwest Indiana Pathology Consultants PC
• Northwest Indiana Rehabilitation Services, Inc.
• Northwest Medical Weight Loss LLC
• Northwestern Imaging, LLC
• Northwestern Medical Imaging LLC
• Nothing But the Tooth LLC

• Foot & Ankle Surgery Podiatrist in Munster, IN
• Providers in Munster, IN by specialty
• Foot & Ankle Surgery Podiatrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2009; 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.