Provider Demographics
NPI:1710997929
Name:ABU-AITA, GEORGE F (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:F
Last Name:ABU-AITA
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 1:1600 S LAKE PARK AVE STE 1102
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6641
Mailing Address - Country:US
Mailing Address - Phone:219-736-6955
Mailing Address - Fax:219-736-6080
Practice Address - Street 1:1600 S LAKE PARK AVE STE 1102
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6641
Practice Address - Country:US
Practice Address - Phone:219-736-6955
Practice Address - Fax:219-736-6080
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010383002084N0600X
IN01038300A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100340500BMedicaid
IN406330AMedicare ID - Type Unspecified