Provider Demographics
NPI:1558662403
Name:GNESSIN, EHUD (MD)
Entity Type:Individual
Prefix:
First Name:EHUD
Middle Name:
Last Name:GNESSIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N SENATE BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1260
Mailing Address - Country:US
Mailing Address - Phone:317-962-3700
Mailing Address - Fax:
Practice Address - Street 1:1801 N SENATE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1260
Practice Address - Country:US
Practice Address - Phone:317-962-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11014697A390200000X
OH35.128997208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program