Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 01079832A | IN |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 01079832A | IN |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 2003004234 | MO |
NPI | 1255306015 |
---|---|
Provider Name | Dr. Enrico Joseph Stazzone |
First Address | Indianapolis, IN 46290-1024 |
Second Address | Indianapolis, IN 46260-1902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 27/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H01770 | (02) | MO |