Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 01060803A | IN |
NPI | 1003866385 |
---|---|
Provider Name | Dr. James A. Shmalo |
First Address | Greenwood, IN 46142-9420 |
Second Address | Greenwood, IN 46142-9420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 09/07/2007 |