| NPI | 1417903774 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODINE DIANE STAEBLER Practice Administrator 317-621-6673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology |
| Additional Taxonomies | 207YX0602X Otolaryngology, Otolaryngic Allergy |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2015-03-10 |