Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 12008168 | IN |
NPI | 1245205392 |
---|---|
Provider Name | Dr. Susan L Zunt |
First Address | Indianapolis, IN 46202-5211 |
Second Address | Indianapolis, IN 46202-5211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000189273 | ANTHEM (01) | |
U32492 | (02) |