Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 07000966A | IN |
Y | 222Z00000X | Podiatrist | 07000966A | IN |
NPI | 1023061991 |
---|---|
Provider Name | Dr. Niels W Ladine |
First Address | Indianapolis, IN 46260-1578 |
Second Address | New Castle, IN 47362-1123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 30/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200441030 | (05) | IN |
U95678 | (02) | IN |