Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 01041412 | IN |
NPI | 1104829746 |
---|---|
Provider Name | Dr. Michael B Pritz |
First Address | Indianapolis, IN 46260-5924 |
Second Address | Indianapolis, IN 46202-1291 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 17/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000638987 | ANTHEM BLUE CROSS AND BLUE SHIELD (01) | IN |
100322860 | (05) | IN |
A89804 | (02) | IN |