HUBERT FORNALIK (NPI# 1255549812) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255549812 |
| Entity Type | Individual |
| Full Name | HUBERT FORNALIK |
| Credential | MD |
| Practice Address |
5340 Holy Cross Pkwy Mishawaka IN 46545-1470 |
| Mailing Address |
100 E Wayne St Ste 510 South Bend IN 46601-2394 |
| Practice Telephone | 5742371328 |
| Mailing Telephone | 5743345400 |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2020-05-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207V00000X | Obstetrics & Gynecology | 01067752A | IN | Allopathic & Osteopathic Physicians |
| N | 207V00000X | Obstetrics & Gynecology | 37108 | IA | Allopathic & Osteopathic Physicians |
| N | 207V00000X | Obstetrics & Gynecology | MT181806 | PA | Allopathic & Osteopathic Physicians |
| Y | 207VX0201X |
Obstetrics & Gynecology Specialization: Gynecologic Oncology |
01067752A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200978000 | 05 |
| Street Address |
5340 HOLY CROSS PKWY |
| City | MISHAWAKA |
| State | IN |
| Zip Code | 46545-1470 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619970183 | Michiana Hematology-oncology, P.C. | Non-Pharmacy Dispensing Site | 5340 Holy Cross Pkwy, Mishawaka, IN 46545-1470 | 2005-05-27 |
| 1740646348 | Renata Robertson | Nurse Practitioner | 5340 Holy Cross Pkwy, Mishawaka, IN 46545-1470 | 2016-01-12 |
| 1558762476 | Kenlyn Marie Laureys | Nurse Practitioner | 5340 Holy Cross Pkwy, Mishawaka, IN 46545-1470 | 2014-09-10 |
| 1730425604 | Beth Johanna Mondschein | Nurse Practitioner | 5340 Holy Cross Pkwy, Mishawaka, IN 46545-1470 | 2012-12-21 |
| 1023370103 | Frances Denean Stapleton | Nurse Practitioner | 5340 Holy Cross Pkwy, Mishawaka, IN 46545 | 2012-06-13 |
| 1487885679 | Jennifer C Ewing | Nurse Practitioner | 5340 Holy Cross Pkwy, Mishawaka, IN 46545-1470 | 2009-08-05 |
| 1750511218 | Mufti Ahmad | Internal Medicine | 5340 Holy Cross Pkwy, Mishawaka, IN 46545-1470 | 2009-07-19 |
| 1649446444 | Rashid Khan | Internal Medicine | 5340 Holy Cross Pkwy, Mishawaka, IN 46545-1470 | 2008-05-01 |
| 1326231689 | Sheila M Fleming | Nurse Practitioner | 5340 Holy Cross Pkwy, Mishawaka, IN 46545 | 2007-08-21 |
| 1003955485 | Michiana Hematology-oncology P C | Obstetrics & Gynecology | 5340 Holy Cross Pkwy, Mishawaka, IN 46545-1470 | 2007-02-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649824103 | Senior Helpers | In Home Supportive Care | 230 Catalpa Drive Suite B, Mishawaka, IN 46545 | 2019-08-01 |
| 1093272114 | Candice Marie Greathouse | Physical Therapy Assistant | 3630 Hickory Road, Mishawaka, IN 46545 | 2019-02-25 |
| 1639662596 | Mishawaka Rcf Lp | Assisted Living Facility | 3630 Hickory Rd, Mishawaka, IN 46545 | 2018-06-14 |
| 1760907299 | Timothy John Howard | Emergency Medicine | 610 1/2 N Main Street, Apartment 1, Mishawaka, IN 46545 | 2017-08-05 |
| 1699203612 | Paridhie Vasudevan | Dentist | 6502 Grape Rd Ste 882, Mishawaka, IN 46545 | 2017-06-03 |
| 1780134650 | Ossip Optometry, PC | Optometrist | 5111 N. Main Street, Suite 200, Mishawaka, IN 46545 | 2016-10-04 |
| 1457730038 | Melissa Anne Douthit | Nurse Practitioner | 3665 Park Pl W Ste 300, Mishawaka, IN 46545 | 2015-05-28 |
| 1558759654 | Spine and Joint Associates of Plymouth, Inc | Chiropractor | 229 Red Coach, Suite 106, Mishawaka, IN 46545 | 2014-12-26 |
| 1609264795 | Spine and Joint Associates of Mishawaka, Inc | Chiropractor | 229 Red Coach Trail, Suite 106, Mishawaka, IN 46545 | 2014-12-26 |
| 1508260795 | Maribel Smith | Counselor | 2989 Heritage Ct, Mishawaka, IN 46545 | 2014-10-16 |
| Find all providers in zip 46545 | ||||
| Taxonomy Code | 207VX0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| Specialization | Gynecologic Oncology |
| An obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003955485 | Michiana Hematology-oncology P C | Obstetrics & Gynecology | 5340 Holy Cross Pkwy, Mishawaka, IN 46545-1470 | 2007-02-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215198080 | Emma Caroline Rossi | Obstetrics & Gynecology | 1030 W. Michigan St., Indianapolis, IN 46202 | 2008-06-24 |
| 1639343619 | Nabila Rasool | Obstetrics & Gynecology | 8111 S Emerson Ave # 204, Indianapolis, IN 46237 | 2008-04-21 |
| 1386634236 | Paul C Liu | Obstetrics & Gynecology | 100 Navarre Pl Ste 4470, South Bend, IN 46601-1168 | 2005-10-24 |
| 1437146081 | John P. Geisler | Obstetrics & Gynecology | 2510 E Dupont Rd Ste 236, Fort Wayne, IN 46825-1603 | 2005-09-29 |
| 1154317675 | James Robert Dunlop | Obstetrics & Gynecology | 8051 S Emerson Ave Ste 400, Indianapolis, IN 46237-8633 | 2005-09-20 |
| 1437153913 | Michael W Method | Obstetrics & Gynecology | 7979 N Shadeland Ave, Ste 310, Indianapolis, IN 46250-2042 | 2005-06-13 |
| 1821482431 | Beacon Medical Group, Inc. | Obstetrics & Gynecology | 100 Navarre Pl Ste 4470, South Bend, IN 46601-1168 | 2015-03-20 |
| 1295141380 | Gynecologic Oncology of Northeast Indiana, LLC | Obstetrics & Gynecology | 1818 Carew St, Suite 250, Fort Wayne, IN 46805-4788 | 2014-07-09 |
| 1053677591 | Sarah Dilley | Obstetrics & Gynecology | 7979 N Shadeland Ave Ste 310, Indianapolis, IN 46250 | 2012-04-10 |
| 1215203559 | Megan Elyse Buechel | Obstetrics & Gynecology | 8402 Harcourt Rd Ste 420, Indianapolis, IN 46260-2053 | 2012-03-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.