Individual
ALLAN O DIEFENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
702 BARNHILL DR, SUITE 0860, INDIANAPOLIS, IN 46202-5128
(317) 630-8970
(317) 630-8958
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
23001934
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23001934
0000000000
IN
Enumeration date
05/05/2009
Last updated
01/29/2014
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