Provider Demographics
NPI:1699732669
Name:BAX, KEVIN C (MD)
Entity type:Individual
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First Name:KEVIN
Middle Name:C
Last Name:BAX
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8402 HARCOURT RD
Mailing Address - Street 2:STE 715
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2074
Mailing Address - Country:US
Mailing Address - Phone:317-338-9450
Mailing Address - Fax:317-338-9567
Practice Address - Street 1:8402 HARCOURT RD
Practice Address - Street 2:STE 715
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2074
Practice Address - Country:US
Practice Address - Phone:317-338-9450
Practice Address - Fax:317-338-9567
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IN01059990A2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology