Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 07000980A | IN |
Y | 222Z00000X | Podiatrist | 07000980A | IN |
N | 213EP1101X | Primary Podiatric Medicine | 07000980A | IN |
NPI | 1598730020 |
---|---|
Provider Name | Ms. Sherese R Dillon |
First Address | Merrillville, IN 46410 |
Second Address | Merrillville, IN 46410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2006 |
Last Update Date | 29/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200281060A | (05) | IN |
U92703 | (02) | IN |