Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 12007429A | IN |
NPI | 1013041979 |
---|---|
Provider Name | Harry Gene Frank |
First Address | Merrillville, IN 46410-6295 |
Second Address | Merrillville, IN 46410-6386 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |