| NPI | 1295087500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY P COSTELLO CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery |
| Additional Taxonomies | 207Y00000X Otolaryngology |
| 231H00000X Audiologist | |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2017-10-12 |