Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 08001693A | IN |
NPI | 1508041070 |
---|---|
Provider Name | Eric Lee Mitz |
First Address | Evansville, IN 47714-7513 |
Second Address | Evansville, IN 47714-7513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2008 |
Last Update Date | 23/05/2014 |