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Individual
FEI LU
Active
Individual
FEI LU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
01078414A
IN
207RC0001X
Clinical Cardiac Electrophysiology Physician
102309
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001163780
BCBS
IN
05
—
300002725
—
IN
01
—
IN1041057
MEDICARE
IN
Enumeration date
10/19/2006
Last updated
11/06/2024
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