Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 01045662A | IN |
NPI | 1083698591 |
---|---|
Provider Name | Dr. Nicholas Ralph Straniero |
First Address | South Bend, IN 46617-1924 |
Second Address | Granger, IN 46530-8039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 05/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200111900 | (05) | IN |
A03024 | (02) | IN |