Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 1037197 | IN |
NPI | 1356332001 |
---|---|
Provider Name | Carol K Fosso |
First Address | Indianapolis, IN 46240-1564 |
Second Address | Indianapolis, IN 46240-1564 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 03/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100132220 | (05) | IN |
E09525 | (02) |