Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 01025466A | IN |
Y | 207RI0011X | Interventional Cardiology | 01025466A | IN |
NPI | 1033175914 |
---|---|
Provider Name | James W Vantassel |
First Address | Indianapolis, IN 46268-3129 |
Second Address | Indianapolis, IN 46260-1992 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 02/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100370050 | (05) | IN |
D95357 | (02) | IN |