Provider Demographics
NPI:1083894976
Name:GODWIN C. UWIDIA, M.D., P.C.
Entity Type:Organization
Organization Name:GODWIN C. UWIDIA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:GODWIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:UWIDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-944-7414
Mailing Address - Street 1:2200 GRANT ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-3439
Mailing Address - Country:US
Mailing Address - Phone:219-944-7414
Mailing Address - Fax:219-944-2462
Practice Address - Street 1:2200 GRANT ST
Practice Address - Street 2:SUITE 206
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-3439
Practice Address - Country:US
Practice Address - Phone:219-944-7414
Practice Address - Fax:219-944-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN625680Medicare PIN