Organization
DERMATOLOGY CENTER OF SOUTHERN INDIANA, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY KATHLEEN MCTIGUE M.D. (PRESIDENT)
(812) 339-6434
Entity
Organization
Contact information
Practice address
1200 S ROGERS ST, BLOOMINGTON, IN 47403-4792
(812) 339-6434
(812) 331-0196
Mailing address
1200 S ROGERS ST, BLOOMINGTON, IN 47403-4792
(812) 339-6434
(812) 331-0196
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100182850
—
IN
Enumeration date
10/16/2006
Last updated
04/11/2016
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