Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 01031677A | IN |
NPI | 1437142759 |
---|---|
Provider Name | Erlinda Roque Kerekes |
First Address | Munster, IN 46321-2807 |
Second Address | Munster, IN 46321-2901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 18/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E09507 | (02) | IN |