Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 01031859A | IN |
NPI | 1932198488 |
---|---|
Provider Name | Robert W Clausen |
First Address | South Bend, IN 46617-2808 |
Second Address | South Bend, IN 46617-2808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 06/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100223450 | (05) | IN |
146470EEE | (02) | IN |
B29441 | (02) | IN |