Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 5101018983 | MI |
Y | 207QS0010X | Family Doctor - Sports Medicine | 02006524A | IN |
N | 207QS0010X | Family Doctor - Sports Medicine | 5101018983 | MI |
NPI | 1245545615 |
---|---|
Provider Name | Jennifer Trpkovski |
First Address | Bloomington, IN 47401-8368 |
Second Address | Bloomington, IN 47401-8368 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2010 |
Last Update Date | 29/10/2021 |