Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 01036326A | IN |
N | 2080P0202X | Pediatric Cardiologist | 01036326A | IN |
NPI | 1184715567 |
---|---|
Provider Name | Lilioza Maria Gzyl |
First Address | Fort Wayne, IN 46808 |
Second Address | Fort Wayne, IN 46808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |