=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043514045
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BABIES AND KIDZ MEDICAL SPECIALISTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2011
-----------------------------------------------------
Last Update Date | 01/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 SOUTH MAIN STREET SAINT ANTHONY MEDICAL CENTE
-----------------------------------------------------
City | CROWN POINT
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46307-8483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-738-2100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6308 PERSHING RD
-----------------------------------------------------
City | SCHERERVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46375-3451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-964-9218
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SUDHISH CHANDRA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 219-964-9218
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080N0001X
-----------------------------------------------------
Taxonomy Name | Neonatal-Perinatal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------