Basic Information
| Provider Information | |||||||||
| NPI: | 1982622239 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOPOR | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 SIERRA DR | ||||||||
| Address2: | STE 400 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461437241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178658540 | ||||||||
| FaxNumber: | 3178658317 | ||||||||
| Practice Location | |||||||||
| Address1: | 7905 CALUMET AVE | ||||||||
| Address2: | |||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463212549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198363296 | ||||||||
| FaxNumber: | 2198363295 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 03/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070015412 | IL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 05007705A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 471400288 | 01 | IN | MEDICARE PTAN | OTHER | 201340970 | 05 | IN | MEDICAID | 568150 | 01 | IL | MEDICARE GROUP NUMBER | OTHER | 568080 | 01 | IL | MEDICARE GROUP NUMBER | OTHER | 1619908 | 01 | IL | BCBS IL GROUP | OTHER | 567700 | 01 | IL | MEDICARE GROUP NUMBER | OTHER |