Provider Information for 1659150464
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BRIAN JERED KADINGER
Sex: Male
NPI: 1659150464
Last Updated: 2023-09-22
Certification Date: 2023-09-22
Certification Date: 2023-09-22
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1659150464 | ||||||||
| Enumeration Date | 2023-09-22 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1177 KENWOOD DR GREENWOOD, IN 46143-7960 United States Phone: 317-650-9540 | Fax: | ||||||||
| Primary Practice Address | 1177 KENWOOD DR GREENWOOD, IN 46143-7960 United States Phone: 317-650-9540 | Fax: | ||||||||
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