Healthcare Provider Details

I. General information

NPI: 1932186954
Provider Name (Legal Business Name): PANNA B BARAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 89TH AVE SUITE 2A
MERRILLVILLE IN
46410-7319
US

IV. Provider business mailing address

200 E 89TH AVE SUITE 2A
MERRILLVILLE IN
46410-7319
US

V. Phone/Fax

Practice location:
  • Phone: 219-736-2800
  • Fax: 219-736-6680
Mailing address:
  • Phone: 219-736-2800
  • Fax: 219-736-6680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01030108
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: