Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 01051503A | IN |
N | 208600000X | Surgeon | 01051503A | IN |
N | 2086S0120X | Pediatric Surgery | 01051503A | IN |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 01051503A | IN |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 35.130739 | OH |
N | 208G00000X | Cardiothoracic Vascular Surgeon | D38502 | MD |
NPI | 1336123249 |
---|---|
Provider Name | Vinu Simon Abraham |
First Address | Indianapolis, IN 46260-2193 |
Second Address | Indianapolis, IN 46260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 21/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000176649 | BCBS PIN (01) | IN |
200251740 | (05) | IN |
2518029 | (05) | OH |
F63615 | (02) |