Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 01054035A | IN |
NPI | 1104870989 |
---|---|
Provider Name | Mr. Todd W Arnold |
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 | 19/05/2006 |
Last Update Date | 03/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080184462 | RR MEDICARE PIN (01) | IN |
200344780 | (05) | IN |
G40166 | (02) | IN |