Provider Demographics
NPI:1811177785
Name:SPINAL & NEUROSURGICAL INSTITUTE P.C.
Entity type:Organization
Organization Name:SPINAL & NEUROSURGICAL INSTITUTE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAAKAJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-942-6501
Mailing Address - Street 1:1600 S LAKE PARK AVE
Mailing Address - Street 2:STE 1102
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6641
Mailing Address - Country:US
Mailing Address - Phone:219-942-6501
Mailing Address - Fax:219-942-0124
Practice Address - Street 1:1600 S LAKE PARK AVE
Practice Address - Street 2:STE 1102
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6641
Practice Address - Country:US
Practice Address - Phone:219-942-6501
Practice Address - Fax:219-942-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050352A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000374099OtherBLUE CROSS BLUE SHIELD
IN200136330AMedicaid
IN220030Medicare PIN
INH02639Medicare UPIN