Individual
BEN H PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1310 S LEBANON ST, LEBANON, IN 46052-2792
(765) 482-7005
Mailing address
1310 S LEBANON ST, LEBANON, IN 46052-2792
(765) 482-7005
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01027843
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100063190
—
IN
Enumeration date
10/31/2006
Last updated
03/29/2021
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