Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Purdue Sports Medicine Wl

Organization Sports Medicine (Internal Medicine) Physician · NPI 1053712570

Purdue Sports Medicine Wl is a Sports Medicine (Internal Medicine) Physician in West Lafayette, Indiana. Registered with an NPI since 2014.

In the registry since
2014
Specialties on file
3

Practice location Address checks out

900 John R Wooden Drive Mackey Arena
West Lafayette, IN 47907
Phone: (765) 494-3245
Fax: (765) 494-9899
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Orthopedic Physical Therapist (primary) Taxonomy 2251X0800X
Sports Medicine (Internal Medicine) Physician Taxonomy 207RS0010X
Athletic Trainer Taxonomy 2255A2300X

Record details

NPI number1053712570
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Joan Vaughan — Hipaa Privacy Officer · (765) 496-1927
NPI enumeratedSeptember 16, 2014
Last updated in NPPESOctober 24, 2014
Mailing address601 Stadium Mall Dr, West Lafayette, IN 47907-2052

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