Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 07001184A | IN |
Y | 222Z00000X | Podiatrist | 07001184A | IN |
NPI | 1033420534 |
---|---|
Provider Name | Brian Thomas Damitz |
First Address | Chesterton, IN 46304-9658 |
Second Address | Chesterton, IN 46304-9658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2010 |
Last Update Date | 13/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300011145 | (05) | IN |