Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 01051714A | IN |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 01051714A | IN |
NPI | 1285643205 |
---|---|
Provider Name | Dr. Dwight S Tyndall |
First Address | Chesterton, IN 46304 |
Second Address | Munster, IN 46321-2938 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 26/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00000092093 | ANTHEM (01) | |
001051714 | BCIL TYNDALL (01) | |
036095677 | (05) | IL |
104771 | ANTHEM GROUP (01) | IN |
1160572 | FIRST HEALTH (01) | |
140220 | MEDICARE GROUP SMMN (01) | |
200135850A | MEDICAID IND GROUP (01) | |
200226250A | (05) | IN |
5797564 | AETNA (01) | |
874640 | MEDICARE GROUP (01) | IN |
90000692 | BCIL GROUP (01) | |
CI3318 | RRMEDICARE GROUP (01) | |
F84214 | (02) | IN |