Individual
LAWRANCE TINOFARA MUKONA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7165 CLEARVISTA WAY, INDIANAPOLIS, IN 46256-4621
(317) 621-5700
Mailing address
7165 CLEARVISTA WAY, INDIANAPOLIS, IN 46256-4621
(317) 621-5700
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
11023063A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300076307
—
IN
Enumeration date
04/04/2023
Last updated
06/12/2023
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