Basic Information
Provider Information
NPI: 1275828329
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LE
FirstName: NHAM
MiddleName: H
NamePrefix:  
NameSuffix:  
Credential: MD
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Mailing Information
Address1: 10330 N MERIDIAN ST # 300
Address2:  
City: INDIANAPOLIS
State: IN
PostalCode: 462901024
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2015 JACKSON ST
Address2:  
City: ANDERSON
State: IN
PostalCode: 46016
CountryCode: US
TelephoneNumber: 7656492511
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/16/2011
LastUpdateDate: 05/18/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XD72520MDN Allopathic & Osteopathic PhysiciansAnesthesiology 
207L00000X01080403AINY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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