Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 01033883A | IN |
N | 111NI0900X | Internist | 01033883A | IN |
Y | 207RR0500X | Rheumatology | 01033883A | IN |
NPI | 1043213689 |
---|---|
Provider Name | Dr. Bruce A. Lockwitz |
First Address | Elkhart, IN 46515-2968 |
Second Address | Elkhart, IN 46514-2066 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 09/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100112850A | (05) | IN |
B28635 | (02) | IN |