Individual
ABALA KOMA TASSIKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5455 W 86TH ST STE 155, INDIANAPOLIS, IN 46268-1540
(309) 644-2037
Mailing address
5455 W 86TH ST STE 155, INDIANAPOLIS, IN 46268-1540
(309) 644-2037
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
08/14/2022
Last updated
08/14/2022
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