Organization
UNIVERSITY OTOLARYNGOLOGY ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD T MIYAMOTO M.D. (PRESIDENT)
(317) 630-8970
Entity
Organization
Contact information
Practice address
705 RILEY HOSPITAL DR, SUITE 0860, INDIANAPOLIS, IN 46202-5109
(317) 630-8970
(317) 630-8958
Mailing address
705 RILEY HOSPITAL DR, SUITE 0860, INDIANAPOLIS, IN 46202-5109
(317) 630-8970
(317) 630-8958
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
50000807A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100228340
—
IN
Enumeration date
07/04/2006
Last updated
08/06/2013
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