Provider Demographics
NPI:1184240269
Name:BAWA, ADITI (MD)
Entity type:Individual
Prefix:MS
First Name:ADITI
Middle Name:
Last Name:BAWA
Suffix:
Gender:F
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:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:IN
Mailing Address - Zip Code:46761-0236
Mailing Address - Country:US
Mailing Address - Phone:260-463-2133
Mailing Address - Fax:260-463-3775
Practice Address - Street 1:2500 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-1158
Practice Address - Country:US
Practice Address - Phone:260-463-2133
Practice Address - Fax:260-463-3775
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2023-10-30
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2022-05-09
Provider Licenses
StateLicense IDTaxonomies
IN01090160A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine