Provider Demographics
NPI:1093170557
Name:NIEHAUS, PERINJIT K (PA-C)
Entity Type:Individual
Prefix:
First Name:PERINJIT
Middle Name:K
Last Name:NIEHAUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PERINJIT
Other - Middle Name:K
Other - Last Name:BACHRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1329
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402-1329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2605 E CREEKS EDGE DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-8368
Practice Address - Country:US
Practice Address - Phone:812-333-2663
Practice Address - Fax:812-676-4131
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001960A363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN090540385OtherMEDICARE PTAN
IN264430390OtherMEDICARE PTAN
IN074790025OtherMEDICARE PTAN
IN300005603Medicaid
INQ00295359OtherRAILROAD PTAN