| Michiana Adult Medical Specialists | |
|
2050 E Ireland Rd South Bend IN 46614-2909 | |
| (574) 222-2359 | |
| (574) 222-2365 |
| Full Name | Michiana Adult Medical Specialists |
|---|---|
| Speciality | Internal Medicine |
| Location | 2050 E Ireland Rd, South Bend, Indiana |
| Authorized Official Name and Position | Alexander C. Gatzimos (MANAGER) |
| Authorized Official Contact | 5742498663 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michiana Adult Medical Specialists 2050 E Ireland Rd South Bend IN 46614-2909 Ph: (574) 222-2359 | Michiana Adult Medical Specialists 2050 E Ireland Rd South Bend IN 46614-2909 Ph: (574) 222-2359 |
| NPI Number | 1154663763 |
|---|---|
| Provider Enumeration Date | 03/21/2013 |
| Last Update Date | 10/01/2013 |
| Medicare PECOS PAC ID | 7911131792 |
|---|---|
| Medicare Enrollment ID | O20131010000141 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154663763 | NPI | - | NPPES |
| D95574 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | 01036818A (Indiana) | Primary |
| Provider Name | Alexander C Gatzimos |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548476120 PECOS PAC ID: 3870565773 Enrollment ID: I20040811000363 |
| Provider Name | Caitlin E Pribble |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689224214 PECOS PAC ID: 6901232412 Enrollment ID: I20200131001438 |
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