| NPI | 1104877141 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL O KOCH President 317-944-7338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: IN 01048495A) |
| Additional Taxonomies | 2088P0231X (Licence: IN 01048495A) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: IN 71001248A) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2024-01-19 |