| NPI | 1720539075 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER CACCAVALLO Internal Medicine Physician 317-513-0538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IN 10002130A) |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2016-10-21 |