DWAINE SIADE (NPI# 1316167307) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316167307 |
| Entity Type | Individual |
| Full Name | DWAINE SIADE |
| Credential | PA-C |
| Practice Address |
611 Lincoln Way East Suite 1 South Bend IN 46601 |
| Practice Telephone | 5748551090 |
| Practice Fax Number | 5748554660 |
| Mailing Telephone | 5748551090 |
| Mailing Fax Number | 5748554660 |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2019-08-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 10000778A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
611 LINCOLN WAY EAST SUITE 1 |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447610449 | David Thomas | Hearing Instrument Specialist | 808 S Michigan St., South Bend, IN 46601 | 2016-03-03 |
| 1285072454 | Kevin Francis Cumper | Internal Medicine | 621 Memorial Dr Ste 624, South Bend, IN 46601 | 2013-06-11 |
| 1952605560 | Robert Lusk Bonham | Dentist | 1222 L.w.e., So. Bend, IN 46601 | 2010-12-23 |
| 1649580911 | Daniel Scott Debrule | Psychologist | 211 W. Washington Street, Suite 2311, South Bend, IN 46601 | 2010-10-20 |
| 1528390770 | Luke Alfred White | Internal Medicine | 615 N. Michigan St., Memorial Hospital, C/o Erin Smith, South Bend, IN 46601 | 2010-02-12 |
| 1548497837 | Tmg Home Health Care | Home Health | 108 N Main St #305, South Bend, IN 46601 | 2009-06-15 |
| 1225283039 | Jody L. Hughes | Counselor | 202 S. Michigan Street, Suite 875, South Bend, IN 46601 | 2008-11-20 |
| 1740432574 | Amanda Jayne Quicksall | Social Worker | 611 Lincolnway W, South Bend, IN 46601 | 2008-10-10 |
| 1952565772 | Thomas P Judd | Dentist | 1901 #b Western Avenue, Ihc South Bend, South Bend, IN 46601 | 2008-07-10 |
| 1851590269 | Warren Larry Penrod | Nurse Practitioner | 333 W. Western Ave, South Bend, IN 46601 | 2007-07-16 |
| Find all providers in zip 46601 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245421031 | Lisa D Raderstorf | Physician Assistant | 5838 W Brick Rd, Suite 106, South Bend, IN 46628-8423 | 2007-08-06 |
| 1699764308 | Gary L. Armock | Physician Assistant | 53880 Carmichael Dr, South Bend, IN 46635-1567 | 2005-10-14 |
| 1568454940 | Sheri A Wilson | Physician Assistant | 1245 E Ireland Rd, South Bend, IN 46614-3448 | 2005-08-22 |
| 1740803238 | Taylor Reinhardt | Physician Assistant | 615 N Michigan St, South Bend, IN 46601-1033 | 2020-05-19 |
| 1073155420 | Priya Kaur | Physician Assistant | 1245 E Ireland Rd, South Bend, IN 46614-3448 | 2019-10-16 |
| 1730720301 | Mackenzie S Warrick | Physician Assistant | 53880 Carmichael Dr, South Bend, IN 46635-1567 | 2019-10-03 |
| 1649736604 | Meghan M. Hart | Physician Assistant | 100 Navarre Pl Ste 4440, South Bend, IN 46601-1171 | 2019-02-14 |
| 1477021038 | Ashlee Dennise Swafford | Physician Assistant | 615 N Michigan St, South Bend, IN 46601-1033 | 2018-11-12 |
| 1801300330 | Alejandro Mikelonis | Physician Assistant | 610 N Michigan St Ste 306, South Bend, IN 46601-1079 | 2017-11-20 |
| 1295256808 | Elizabeth D. Progar | Physician Assistant | 610 N Michigan St Ste 306, South Bend, IN 46601-1079 | 2017-07-05 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46601 |
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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.