Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301087486 | MI |
N | 111NI0900X | Internist | 4301087486 | MI |
Y | 207RC0000X | Internist - Cardiovascular Disease | 01072452A | IN |
NPI | 1013111475 |
---|---|
Provider Name | Dr. Mihas Mamu Kodenchery |
First Address | Merrillville, IN 46410-2601 |
Second Address | Merrillville, IN 46410-2601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 09/02/2014 |