Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 01024403A | IN |
NPI | 1114956497 |
---|---|
Provider Name | Dr. Thomas R. Keucher |
First Address | South Bend, IN 46601-1156 |
Second Address | South Bend, IN 46601-1156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 14/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100346270A | (05) | IN |
B29690 | (02) | IN |