Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 1030137A | IN |
NPI | 1063478873 |
---|---|
Provider Name | Michael Cletus Dalsing |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-1228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 13/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100129470A | (05) | IN |
E14003 | (02) | IN |