Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 01067944A | IN |
N | 111NI0900X | Internist | 01067944A | IN |
N | 207RC0200X | Critical Care Medicine | 01067944A | IN |
Y | 207RP1001X | Pulmonary Disease | 01067944A | IN |
NPI | 1013116334 |
---|---|
Provider Name | Edward Paul Mintz |
First Address | Indianapolis, IN 46260-1316 |
Second Address | Indianapolis, IN 46260-2279 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2007 |
Last Update Date | 14/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200989990 | (05) | IN |