Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 01023737A | IN |
NPI | 1033113550 |
---|---|
Provider Name | Fayez S Tushan |
First Address | Indianapolis, IN 46219-4817 |
Second Address | Indianapolis, IN 46256-4640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 30/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100318520A | (05) | IN |
D95342 | (02) | IN |