Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 01078150A | IN |
N | 207X00000X | Orthopaedic Surgeon | 35.092334 | OH |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 01078150A | IN |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME106825 | FL |
NPI | 1184883571 |
---|---|
Provider Name | Dr. David Michael Foulk |
First Address | Indianapolis, IN 46250-2890 |
Second Address | Indianapolis, IN 46256-5604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2008 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
266180961 | MEDICARE PIN (01) | IN |
300001069 | (05) | IN |