Provider Demographics
NPI:1669688222
Name:GITA R BARUAH MD SC
Entity Type:Organization
Organization Name:GITA R BARUAH MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARUAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-219-3031
Mailing Address - Street 1:19175 STILL POINT TRL
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-4808
Mailing Address - Country:US
Mailing Address - Phone:414-219-3031
Mailing Address - Fax:
Practice Address - Street 1:945 N 12TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1305
Practice Address - Country:US
Practice Address - Phone:414-219-3031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30483600Medicaid
WI30483600Medicaid
WI000273023Medicare PIN