Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 07000364A | IN |
NPI | 1487704680 |
---|---|
Provider Name | Dr. Mann Spitler III |
First Address | Valparaiso, IN 46383-2433 |
Second Address | Valparaiso, IN 46383-2433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000079093 | ANTHEM BCBS PIN# (01) | IN |
T34967 | (02) | IN |