Provider Demographics
NPI:1558585034
Name:NITIN S SARDESAI MD PC
Entity Type:Organization
Organization Name:NITIN S SARDESAI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NITIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SARDESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-836-2055
Mailing Address - Street 1:9307 CALUMET AVE
Mailing Address - Street 2:SUITE D1
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2891
Mailing Address - Country:US
Mailing Address - Phone:219-836-2055
Mailing Address - Fax:219-836-0355
Practice Address - Street 1:9307 CALUMET AVE
Practice Address - Street 2:SUITE D1
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2891
Practice Address - Country:US
Practice Address - Phone:219-836-2055
Practice Address - Fax:219-836-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029300207Q00000X
IN01059155A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100200740Medicaid
625250Medicare ID - Type Unspecified
IN100200740Medicaid