Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 01051568A | IN |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 01051568A | IN |
NPI | 1205889276 |
---|---|
Provider Name | Mr. Lance A Rettig |
First Address | Indianapolis, IN 46280-1393 |
Second Address | Indianapolis, IN 46280-1393 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 17/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H90579 | (02) | IN |