Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 07001308A | IN |
NPI | 1306295084 |
---|---|
Provider Name | Melanie S. Kocevar |
First Address | Fort Wayne, IN 46845-1703 |
Second Address | Huntington, IN 46750-1291 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2016 |
Last Update Date | 30/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
41000343A | IN MEDICAL LICENSE (01) | IN |