Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 01031760 | IN |
NPI | 1104850262 |
---|---|
Provider Name | Alan Michael Sadove |
First Address | Indianapolis, IN 46290-1004 |
Second Address | Indianapolis, IN 46290-1004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 09/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E78143 | (02) |