Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 12006898A | IN |
NPI | 1689678666 |
---|---|
Provider Name | Dr. Charles Edward Tomich |
First Address | Indianapolis, IN 46260-1828 |
Second Address | Indianapolis, IN 46260-1828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 15/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T81858 | (02) | IN |