Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 07000788 | IN |
NPI | 1063412526 |
---|---|
Provider Name | Kathleen T Neuhoff |
First Address | South Bend, IN 46617-2902 |
Second Address | South Bend, IN 46617-2902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2005 |
Last Update Date | 08/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100379720A | (05) | IN |
U50205 | (02) |