Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 20042474A | IN |
NPI | 1619449329 |
---|---|
Provider Name | Dr. Kevin Lee Rand |
First Address | Indianapolis, IN 46205-1822 |
Second Address | Indianapolis, IN 46205-1822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2018 |
Last Update Date | 19/12/2018 |