Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 01062183 | IN |
NPI | 1740334317 |
---|---|
Provider Name | Richard J. Balikian |
First Address | Indianapolis, IN 46290-1004 |
Second Address | Indianapolis, IN 46290-1004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |