Basic Information
| Provider Information | |||||||||
| NPI: | 1285643205 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TYNDALL | ||||||||
| FirstName: | DWIGHT | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 GATEWAY AVE | ||||||||
| Address2: | |||||||||
| City: | CHESTERTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199211444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 759 45TH ST | ||||||||
| Address2: | |||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463212938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199211444 | ||||||||
| FaxNumber: | 2199215303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 01051714A | IN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0117X | 01051714A | IN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 200226250A | 05 | IN | MEDICAID | 140220 | 01 | MEDICARE GROUP SMMN | OTHER | 90000692 | 01 | BCIL GROUP | OTHER | 001051714 | 01 | BCIL TYNDALL | OTHER | 104771 | 01 | IN | ANTHEM GROUP | OTHER | 5797564 | 01 | AETNA | OTHER | CI3318 | 01 | RRMEDICARE GROUP | OTHER | 036095677 | 05 | IL | MEDICAID | 1160572 | 01 | FIRST HEALTH | OTHER | 200135850A | 01 | MEDICAID IND GROUP | OTHER | 00000092093 | 01 | ANTHEM | OTHER | 874640 | 01 | IN | MEDICARE GROUP | OTHER |