Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 01039340 | IN |
N | 207RR0500X | Rheumatology | 01039340A | IN |
NPI | 1124057419 |
---|---|
Provider Name | Mr. Alan J Birnbaum |
First Address | South Bend, IN 46601-1169 |
Second Address | South Bend, IN 46601-1169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 14/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000226107 | BLUE CROSS (01) | IN |
E93636 | (02) | IN |