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Individual
DR. MICHAEL CHRISTOPHER LARGE
Active
Individual
DR. MICHAEL CHRISTOPHER LARGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01072896A
IN
208800000X
Urology Physician
125-049267
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000826877
ANTHEM PIN
IN
01
—
100194370
GROUP MEDICAID NUMBER
IN
01
—
1487680518
GROUP NPI
IN
01
—
1548340177
NAAB ROAD DME NPI
IN
01
—
200288740
GROUP MEDICAID NUMBER
IN
05
—
201191980
—
IN
Enumeration date
02/11/2009
Last updated
01/19/2024
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