| NPI | 1730442559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GOHAR AZAM SALAM Sole Mbr 260-483-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: IN 13 012741 1) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: IN 01058885A) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2016-03-03 |