Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 12006401 | IN |
NPI | 1124127238 |
---|---|
Provider Name | Dr. John E Marosky |
First Address | Kokomo, IN 46902-3601 |
Second Address | Kokomo, IN 46902-3601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |