Individual
TECHSIN T TY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3608 S LAFOUNTAIN ST UNIT A, KOKOMO, IN 46902-3809
(765) 776-8666
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01046041
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200111710
—
IN
Enumeration date
07/28/2005
Last updated
01/15/2024
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