| NPI | 1457331522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN ROSE DVORAK Administrator 317-913-8170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IN 01034557A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01034557A) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2020-08-22 |