Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 01054684A | IN |
N | 208600000X | Surgeon | 01054684A | IN |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 01054684 | IN |
NPI | 1104914340 |
---|---|
Provider Name | John H Storey |
First Address | Indianapolis, IN 46250-2805 |
Second Address | Indianapolis, IN 46250-2693 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 14/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000200146 | ANTHEM (01) | |
000000569479 | ANTHEM (01) | IN |
200333850 | (05) | IN |
399892 | WELLCARE (01) | IN |
5528673 | AETNA (01) | IN |
CB8082 | TRICARE (01) | |
F07926 | (02) | |
P01209643 | RR MEDICARE PTAN (01) | IN |