Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 01035981 | IN |
NPI | 1427023423 |
---|---|
Provider Name | Mark Holbreich |
First Address | Indianapolis, IN 46206-6069 |
Second Address | Indianapolis, IN 46260-5382 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 25/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000076229 | ANTHEM (01) | IN |
100327390 | (05) | IN |
D95268 | (02) | IN |