| NPI | 1629258470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOHAMMAD REZA SIADATI Owner/Physician 765-278-4227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IN 01048160A) |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2007-11-09 |