Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 01047781A | IN |
N | 207QA0401X | Family Doctor - Addiction Medicine | 01047781A | IN |
NPI | 1801863857 |
---|---|
Provider Name | Pamela A Middleton |
First Address | Chicago, IL 60677-6351 |
Second Address | Clarksville, IN 47129-2278 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 28/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000547192 | ANTHEM - NORTON (01) | IN |
200215460 | (05) | IN |
G74902 | (02) | IN |