Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 01066995A | IN |
N | 207QS0010X | Family Doctor - Sports Medicine | 01066995A | IN |
NPI | 1023225901 |
---|---|
Provider Name | Haihong Mao |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46229-3032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 17/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200947620 | (05) | IN |