Unknown Individual – Medical Physician Assistant, NPI 1124495650
Medical Physician Assistant
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NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
5215 Holy Cross Parkway
Mishawaka, IN 465451469
Phone: (574) 523-3160
Type: Location
710 N NILES AVE
SOUTH BEND, IN 466171924
Phone: (574) 647-1610
Fax: (574) 237-6069
Type: Mailing
714 N MICHIGAN ST
SOUTH BEND, IN 46601
Phone: (574) 647-7477
Fax: (574) 647-3655
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 46545)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Cardiovascular Disease (Cardiology), Interventional Cardiology | IN | |
| Nurse Practitioner | IN | |
| - | IN | |
| Qualified Audiologist | IN | |
| Nurse Practitioner | IN | |
| - | IN | |
| Nurse Practitioner | IN | |
| - | IN | |
| General Surgery | IN | |
| - | IN |
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