Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 01023844 | IN |
Y | 207X00000X | Orthopaedic Surgeon | 01023844A | IN |
NPI | 1831147727 |
---|---|
Provider Name | Thomas J Cittadine |
First Address | Indianapolis, IN 46250-2805 |
Second Address | Noblesville, IN 46060-5006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 23/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100125860A | (05) | IN |
E14740 | (02) | IN |
P01424295 | RR MEDICARE (01) |