Provider Demographics
NPI:1164536587
Name:BLOOMINGTON KIDNEY & HYPERTENSION SPECIALISTS PC
Entity Type:Organization
Organization Name:BLOOMINGTON KIDNEY & HYPERTENSION SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HIDEKI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAWANISHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-333-8194
Mailing Address - Street 1:PO BOX 6715
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47407-6715
Mailing Address - Country:US
Mailing Address - Phone:812-333-8194
Mailing Address - Fax:812-333-8237
Practice Address - Street 1:515 S WOODSCREST DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401
Practice Address - Country:US
Practice Address - Phone:812-333-8194
Practice Address - Fax:812-333-8237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200498840AMedicaid
IN227970Medicare ID - Type Unspecified