Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 01056178A | IN |
NPI | 1639128127 |
---|---|
Provider Name | Jonathan Aaron Fridell |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 11/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200384130A | (05) | IN |
H76181 | (02) | IN |