Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 01054298A | IN |
NPI | 1063407872 |
---|---|
Provider Name | Hesham M Bazaraa |
First Address | Greenwood, IN 46143-7241 |
Second Address | Munster, IN 46321-2899 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 15/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200340980 | (05) | IN |
200340980A | (05) | IN |
G49899 | (02) |