Provider Demographics
NPI:1588806913
Name:BAXI UROLOGY PC
Entity Type:Organization
Organization Name:BAXI UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NISHENDU
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-218-9475
Mailing Address - Street 1:PO BOX 3070
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-0070
Mailing Address - Country:US
Mailing Address - Phone:219-218-9475
Mailing Address - Fax:866-794-9475
Practice Address - Street 1:9250 COLUMBIA AVE
Practice Address - Street 2:STE. #2A
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3538
Practice Address - Country:US
Practice Address - Phone:219-218-9475
Practice Address - Fax:866-794-9475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060538A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C45074Medicare UPIN
IN261290Medicare PIN