Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 02001725 | IN |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 02001725A | IN |
NPI | 1053363002 |
---|---|
Provider Name | Mark J Dilella |
First Address | Indianapolis, IN 46278-1381 |
Second Address | Greenwood, IN 46143-3602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200081810 | (05) | IN |
G25282 | (02) | IN |