Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 07001129A | IN |
Y | 222Z00000X | Podiatrist | 07001129A | IN |
NPI | 1053540906 |
---|---|
Provider Name | Julia K. Pagano |
First Address | Elkhart, IN 46514-1228 |
Second Address | Elkhart, IN 46514-1228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2009 |
Last Update Date | 03/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201073380 | (05) | IN |