=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396828638
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDRU N NITU MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2006
-----------------------------------------------------
Last Update Date | 03/24/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 990 E STATE ROAD 44
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46131-9199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-736-5151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 990 E STATE ROAD 44
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46131-9199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-736-5151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | 01055368
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------