Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 01038246A | IN |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 01038246A | IN |
NPI | 1316026545 |
---|---|
Provider Name | Peter J Hillsamer |
First Address | Lafayette, IN 47909-2708 |
Second Address | Lafayette, IN 47909-2708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 16/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100232740 | (05) | IN |
E66985 | (02) |