MEDICARE: BAXI UROLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	01060538A	IN

General Provider Information

NPI Number	:	1588806913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAXI UROLOGY PC

Provider Business Mailing Address
First Line	:	PO BOX 3070
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-0070
Country	:	US
Telephone Number	:	219-218-9475
Fax Number	:	866-794-9475

Provider Business Practice Location Address
First Line	:	9250 COLUMBIA AVE
Second Line	:	STE. #2A
City	:	MUNSTER
State	:	IN
Zip	:	46321-3538
Country	:	US
Telephone Number	:	219-218-9475
Fax Number	:	866-794-9475

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NISHENDU BAXI
Credential	:	M.D.
Telephone Number	:	219-218-9475

Provider Enumeration Date	:	03/31/2009
Last Update Date	:	04/15/2015

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