Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 01071583A | IN |
N | 2080P0203X | Pediatric Critical Care Doctor | 426479 | PA |
NPI | 1194954420 |
---|---|
Provider Name | Paul William Halczenko |
First Address | Indianapolis, IN 46290-1024 |
Second Address | Indianapolis, IN 46260-1902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2009 |
Last Update Date | 21/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001393000 | (05) | FL |
CH862Z | MEDICARE PTAN (01) | FL |