Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 01061668A | IN |
N | 207X00000X | Orthopaedic Surgeon | A91695 | CA |
NPI | 1013995711 |
---|---|
Provider Name | George Wendell M. Feliciano |
First Address | Indianapolis, IN 46250-2890 |
Second Address | Indianapolis, IN 46256-5630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 16/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000485928 | ANTHEM (01) | IN |
000000764488 | ANTHEM (01) | IN |
200821830 | (05) | IN |
I34081 | (02) | IN |
P01134239 | MEDICARE RAILROAD (01) | IN |