Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 01057519A | IN |
NPI | 1003851346 |
---|---|
Provider Name | Dr. Michael Tim Dunfee |
First Address | Spencer, IN 47460-6009 |
Second Address | Bloomington, IN 47403-2317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B45576 | (02) | IN |