Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 01032429A | IN |
Y | 111NI0900X | Internist | 01032429A | IN |
N | 207RG0300X | Geriatric Medicine | 01032429A | IN |
NPI | 1124248935 |
---|---|
Provider Name | Dr. Stephen Alan Rappaport |
First Address | Indianapolis, IN 46240-2502 |
Second Address | Indianapolis, IN 46260-1857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 15/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100228190A | (05) | IN |
B29475 | (02) |