Facts
- Status
- A
- Credential
- M.A.
- Type
- Individual
- Enumeration date
- 2009-03-12
- Last updated
- 2009-03-12
Specialties
Licenses
- License IN
- 46001930A
Location
- Practice location
- 10117 OAK HAVEN DR
- City
- MC CORDSVILLE IN
- Postal code
- 460554411
- Phone
- 317-531-3952
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.