Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 01078024A | IN |
NPI | 1295933349 |
---|---|
Provider Name | Kofi Dela Quist |
First Address | Indianapolis, IN 46250-2054 |
Second Address | Indianapolis, IN 46237-8634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 26/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300003131 | (05) | IN |