Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 01063310A | IN |
Y | 207RP1001X | Pulmonary Disease | 01063310A | IN |
N | 207RS0012X | Sleep Medicine | 01063310A | IN |
NPI | 1083699904 |
---|---|
Provider Name | Dr. Brian Paul Dickover |
First Address | Greenwood, IN 46143-7241 |
Second Address | Michigan City, IN 46360-0021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 15/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200862220 | (05) | IN |