Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 01057842A | IN |
Y | 111NI0900X | Internist | 01057842A | IN |
N | 208000000X | Pediatrician | 01057842A | IN |
N | 2080P0205X | Pediatric Endocrinologist | 01057842 | IN |
NPI | 1326178971 |
---|---|
Provider Name | Erik Allen Imel |
First Address | Indianapolis, IN 46204-1207 |
Second Address | Indianapolis, IN 46202-5149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200858580 | (05) | IN |
I74246 | (02) | IN |