Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 01048016 | IN |
NPI | 1013008465 |
---|---|
Provider Name | Gregory Bauwens |
First Address | Chicago, IL 60686-0001 |
Second Address | Indianapolis, IN 46260-1902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 19/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F97459 | (02) | IN |