Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 02004616A | IN |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 02004616A | IN |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 02004616A | IN |
NPI | 1003111063 |
---|---|
Provider Name | Brian E Camilleri |
First Address | Muncie, IN 47304-5407 |
Second Address | Anderson, IN 46013-9684 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2011 |
Last Update Date | 28/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201396880 | (05) | IN |
207610023 | MEDICARE (01) | IN |