Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 01041329A | IN |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 01041329A | IN |
NPI | 1083688436 |
---|---|
Provider Name | Richard I Fogel |
First Address | Indianapolis, IN 46260-1316 |
Second Address | Indianapolis, IN 46290 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 30/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100342320 | (05) | IN |
F55797 | (02) | IN |