Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 01041503 | IN |
NPI | 1053377929 |
---|---|
Provider Name | Stanley M Spinola |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 18/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100345870 | (05) | IN |
C89516 | (02) | IN |