Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 01025163 | IN |
NPI | 1073666749 |
---|---|
Provider Name | Larry M Salberg |
First Address | Merrillville, IN 46410-6173 |
Second Address | Merrillville, IN 46410-6173 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 24/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
84102 | ANTHEM (01) | |
B28836 | (02) |