Provider Demographics
NPI:1033942297
Name:UROLOGIC SURGERY OF NWI, PC
Entity type:Organization
Organization Name:UROLOGIC SURGERY OF NWI, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GENRI
Authorized Official - Middle Name:
Authorized Official - Last Name:PINKHASOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-693-6363
Mailing Address - Street 1:282 LARWICK CIR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-9305
Mailing Address - Country:US
Mailing Address - Phone:917-693-6363
Mailing Address - Fax:
Practice Address - Street 1:282 LARWICK CIR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-9305
Practice Address - Country:US
Practice Address - Phone:917-693-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1639370893Medicaid