Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 01053980 | IN |
NPI | 1003832882 |
---|---|
Provider Name | Charles Kalsted |
First Address | Bloomington, IN 47402-4777 |
Second Address | Seymour, IN 47274-2363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 16/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200247780 | (05) | IN |
A48464 | (02) |