Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 01081874A | IN |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 01081874A | IN |
NPI | 1467892232 |
---|---|
Provider Name | Dr. George Lungren Vestermark |
First Address | Indianapolis, IN 46278-1381 |
Second Address | Indianapolis, IN 46278-1381 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2013 |
Last Update Date | 27/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300027715 | (05) | IN |