| NPI | 1154541795 |
|---|---|
| Doing Business As | PASSPORT HEALTH INDIANA |
| Entity Type | Organization |
| Authorized Contact | MICHAEL DURS President 317-844-2990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2020-08-22 |