Provider Demographics
NPI:1568651511
Name:GEORGE F ABU-AITA MD PC
Entity Type:Organization
Organization Name:GEORGE F ABU-AITA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:F
Authorized Official - Last Name:ABU-AITA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-736-6955
Mailing Address - Street 1:200 E 89TH AVE
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7318
Mailing Address - Country:US
Mailing Address - Phone:219-736-6955
Mailing Address - Fax:219-736-6080
Practice Address - Street 1:200 EAST 89TH AVENUE
Practice Address - Street 2:SUITE 3B
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7318
Practice Address - Country:US
Practice Address - Phone:219-736-6955
Practice Address - Fax:219-736-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010383002084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN406330Medicare PIN