Individual
DR. DESTINY J HAUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1120 W MICHIGAN ST # CL642, INDIANAPOLIS, IN 46202-5209
(404) 822-4779
Mailing address
1447 W FRY ST APT 3, CHICAGO, IL 60642-5431
(404) 822-4779
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/17/2018
Last updated
05/17/2018
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