Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 01075551 | IN |
NPI | 1649362567 |
---|---|
Provider Name | Chandy C John |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5254 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 18/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201308880 | (05) | IN |