B Waldo Md Llc | |
3000 Pepper Creek Bridge Pkwy Valparaiso IN 46385-7129 | |
(773) 520-1950 | |
Not Available |
Full Name | B Waldo Md Llc |
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Speciality | Internal Medicine |
Location | 3000 Pepper Creek Bridge Pkwy, Valparaiso, Indiana |
Authorized Official Name and Position | Bryan E Waldo (OWNER) |
Authorized Official Contact | 7735201950 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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B Waldo Md Llc 3000 Pepper Creek Bridge Pkwy Valparaiso IN 46385-7129 Ph: (773) 520-1950 | B Waldo Md Llc 3000 Pepper Creek Bridge Pkwy Valparaiso IN 46385-7129 Ph: (773) 520-1950 |
NPI Number | 1043994262 |
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Provider Enumeration Date | 06/09/2023 |
Last Update Date | 06/09/2023 |
Medicare PECOS PAC ID | 9133581572 |
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Medicare Enrollment ID | O20230816002390 |
Identifier | Type | State | Issuer |
---|---|---|---|
1043994262 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Bryan E Waldo |
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Provider Type | Practitioner - Nephrology |
Provider Identifiers | NPI Number: 1982716486 PECOS PAC ID: 7719909456 Enrollment ID: I20080313000123 |
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