Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 01046483 | IN |
NPI | 1467411835 |
---|---|
Provider Name | Mr. Leonard Vincent Covello |
First Address | Munster, IN 46321 |
Second Address | Munster, IN 46321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200151360A | (05) | IN |
F66646 | (02) |