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General NPI Number Information
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NPI Number | 1871655589
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Entity Type | Individual
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Provider Name | SRBISLAV N BRASOVAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/16/2006
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Last Update Date | 08/04/2010
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Provider Practice Location Address
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Address Line | 111 W 10TH ST SUITE 100
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City | HOBART
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State | IN
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Zip | 46342-5990
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Country | US
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Telephone | 219-738-2742
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Fax | 219-942-0740
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Provider Business Mailing Address
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Address Line | 7903 E 97TH AVE
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City | CROWN POINT
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State | IN
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Zip | 46307-8599
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Country | US
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Telephone | 219-738-2742
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Fax | 219-942-0740
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 01022104A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 036103826
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License Number State | IL
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