Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 01056126A | IN |
NPI | 1548294085 |
---|---|
Provider Name | Richard Christopher Miyamoto |
First Address | Indianapolis, IN 46290-1024 |
Second Address | Indianapolis, IN 46260-2053 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 19/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H74102 | (02) | IN |