Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 01072758A | IN |
Y | 207RC0000X | Internist - Cardiovascular Disease | 01072758A | IN |
NPI | 1306968219 |
---|---|
Provider Name | Angela G Brittsan |
First Address | Detroit, MI 48278-1076 |
Second Address | Indianapolis, IN 46237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 17/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201199880 | (05) | IN |