Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 01026350 | IN |
Y | 208600000X | Surgeon | 01026350 | IN |
N | 2082S0105X | Plastic Hand Surgeon | 01026350 | IN |
NPI | 1417020504 |
---|---|
Provider Name | Mr. Nicholas Chris Retson |
First Address | Merrillville, IN 46410-5303 |
Second Address | Merrillville, IN 46410-5303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 14/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000000184599 | ANTHEM (01) | IN |
100339140A | (05) | IN |
B28829 | (02) | IN |