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General NPI Number Information
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NPI Number | 1982716486
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Entity Type | Individual
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Provider Name | BRYAN WALDO M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 2711 LEONARD DR STE 101
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City | VALPARAISO
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State | IN
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Zip | 46383-7121
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Country | US
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Telephone | 219-462-6001
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Fax | 219-464-6060
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Provider Business Mailing Address
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Address Line | 120 W 22ND ST STE 200
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City | OAK BROOK
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State | IL
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Zip | 60523-1563
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Country | US
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Telephone | 630-575-5000
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Fax |
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 01064566A
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License Number State | IN
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