Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0300X | Geriatric Medicine | 432084194 | IN |
NPI | 1073774485 |
---|---|
Provider Name | Austin Nwaka |
First Address | Indianapolis, IN 46205-3113 |
Second Address | Indianapolis, IN 46205-3113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2008 |
Last Update Date | 16/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200383070A | (05) | IN |