| NPI | 1265489975 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW KELLAR Regional Practice Administrator 765-457-8381 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: IN 0104783A) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2007-11-16 |