Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 01034323 | IN |
NPI | 1376627810 |
---|---|
Provider Name | Chandan Singh Thethi |
First Address | Marion, IN 46952-1536 |
Second Address | Marion, IN 46952-1735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100123880 | (05) | IN |
D69526 | (02) | IN |