Provider Demographics
NPI:1053424903
Name:TEAM PHYSICIANS OF INDIANA
Entity type:Organization
Organization Name:TEAM PHYSICIANS OF INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENOIT
Authorized Official - Middle Name:O
Authorized Official - Last Name:CHOINIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-756-6600
Mailing Address - Street 1:403 W 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE BRA
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5317
Mailing Address - Country:US
Mailing Address - Phone:219-756-6600
Mailing Address - Fax:
Practice Address - Street 1:403 W 81ST AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE BRA
Practice Address - State:IN
Practice Address - Zip Code:46410-5317
Practice Address - Country:US
Practice Address - Phone:219-756-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5623260001Medicare NSC