Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 02000141A | IN |
NPI | 1003036526 |
---|---|
Provider Name | Dr. Keith Milo Ernst |
First Address | Cloverdale, IN 46120-0188 |
Second Address | Cloverdale, IN 46120-0188 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |