Organization
SOUTHERN INDIANA DIABETES AND ENDOCRINOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VASTI BROADSTONE MD (PHYSICIAN)
(812) 949-5700
Entity
Organization
Contact information
Practice address
2019 STATE ST, NEW ALBANY, IN 47150-4921
(812) 949-5700
(812) 949-5979
Mailing address
1008 FOX HUNTERS PT, NEW ALBANY, IN 47150-9251
(812) 949-5700
(812) 949-5979
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200332950A
—
IN
05
—
65935603
—
KY
Enumeration date
12/04/2006
Last updated
03/11/2014
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