Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 12008922A | IN |
NPI | 1134252364 |
---|---|
Provider Name | Dr. Mark David Magura |
First Address | Merrillville, IN 46410-6386 |
Second Address | Merrillville, IN 46410-6386 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |