Individual
EDWIN A UDANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
221 US HIGHWAY 41 STE 1, SCHERERVILLE, IN 46375-1277
(219) 864-3950
(219) 864-3952
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02001229A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0090000854
BCBS GROUP NUMBER
IL
05
—
100147500
—
IN
Enumeration date
10/03/2005
Last updated
09/13/2023
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