Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 01072583A | IN |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 01072583A | IN |
NPI | 1093966269 |
---|---|
Provider Name | Brent A Suozzi |
First Address | Indianapolis, IN 46237-8633 |
Second Address | Indianapolis, IN 46237-8633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2008 |
Last Update Date | 10/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01072583A | LICENSE (01) | IN |
201190860 | (05) | IN |