| NPI | 1992723829 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANICE THOMPSON Credentialing Coordinator 317-806-8260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology |
| 2085N0904X Radiology, Nuclear Radiology | |
| 2085R0204X Radiology, Vascular & Interventional Radiology | |
| 2085U0001X Radiology, Diagnostic Ultrasound | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2023-03-09 |