Provider Demographics
NPI:1649640202
Name:BKRD, INC
Entity type:Organization
Organization Name:BKRD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:ROSS-DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-561-6303
Mailing Address - Street 1:302 GARDEN TRL
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-2710
Mailing Address - Country:US
Mailing Address - Phone:219-561-6303
Mailing Address - Fax:
Practice Address - Street 1:302 GARDEN TRL
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-2710
Practice Address - Country:US
Practice Address - Phone:219-561-6303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065198A207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty