Individual
PERINJIT K NIEHAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2605 E CREEKS EDGE DR, BLOOMINGTON, IN 47401-8368
(812) 333-2663
(812) 676-4131
Mailing address
PO BOX 1329, BLOOMINGTON, IN 47402-1329
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
10001960A
IN
363AS0400X
Surgical Physician Assistant
Primary
10001960A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
074790025
MEDICARE PTAN
IN
01
—
090540385
MEDICARE PTAN
IN
01
—
264430390
MEDICARE PTAN
IN
05
—
300005603
—
IN
01
—
Q00295359
RAILROAD PTAN
IN
Enumeration date
12/28/2015
Last updated
08/07/2023
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