Provider Demographics
NPI:1083726293
Name:BASKIN, SERENA KORTEPETER (MD)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:KORTEPETER
Last Name:BASKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8177 CLEARVISTA PKWY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1662
Practice Address - Country:US
Practice Address - Phone:317-621-7801
Practice Address - Fax:317-621-7205
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12862207Q00000X
IN01067146A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205561Medicaid
NH71029982OtherCIGNA ID
AA47227OtherHARVARD PILGRIM ID
IN200966820Medicaid
NH01Y008991NH03OtherANTHEM ID - GRANTHAM
4147497OtherMVP ID
NH01YP08991NH01OtherANTHEM ID - NLHP
IN200966820Medicaid
NH01Y008991NH03OtherANTHEM ID - GRANTHAM
NH30205561Medicaid