Individual
ALA USTYOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
705 RILEY HOSPITAL DR STE 5960, INDIANAPOLIS, IN 46202-5109
(765) 609-1542
Mailing address
705 RILEY HOSPITAL DR STE 5960, INDIANAPOLIS, IN 46202-5109
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
11022325A
IN
Other
Enumeration date
06/15/2022
Last updated
06/15/2022
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