Healthcare Provider Details

I. General information

NPI: 1376657783
Provider Name (Legal Business Name): HIDEKI KAWANISHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S WOODSCREST DR
BLOOMINGTON IN
47401-5524
US

IV. Provider business mailing address

515 S WOODSCREST DR
BLOOMINGTON IN
47401-5524
US

V. Phone/Fax

Practice location:
  • Phone: 812-333-8194
  • Fax: 812-333-8237
Mailing address:
  • Phone: 812-333-8194
  • Fax: 812-333-8237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number01059330A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: