| NPI | 1417641606 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSUE VILLALTA Owner 317-443-8150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2023-06-08 |