| NPI | 1962061135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR MORAN Exec Dir/ CFO 765-284-4266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine |
| 207RS0010X Internal Medicine, Sports Medicine | |
| 207T00000X Neurological Surgery | |
| 207XS0106X Orthopaedic Surgery, Hand Surgery | |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery | |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine | |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery | |
| 207QS0010X Family Medicine, Sports Medicine | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2022-12-14 |