| NPI | 1780466193 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERONICA VOGT Billing Manager 317-836-5719 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2023-10-19 |
| Last Update Date | 2024-02-29 |