Provider Demographics
NPI:1487646055
Name:BAXI, NISHENDU (MD)
Entity Type:Individual
Prefix:
First Name:NISHENDU
Middle Name:
Last Name:BAXI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10190
Mailing Address - Street 2:400 W 84TH DR
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46411-0190
Mailing Address - Country:US
Mailing Address - Phone:219-736-1255
Mailing Address - Fax:219-738-1276
Practice Address - Street 1:400 W 84TH DR
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6248
Practice Address - Country:US
Practice Address - Phone:219-736-1255
Practice Address - Fax:219-738-1276
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060538A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN352029220OtherCOMMERCIAL
IN352029220OtherCOMMERCIAL
C45074Medicare UPIN