| NPI | 1104183375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL J SHANNON CEO 812-282-3899 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208800000X Urology |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2023-08-03 |