Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Mar 27, 2025
License(s)
10004827A (IN)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 705 RILEY HOSPITAL DR | Indianapolis, IN 46202-5109 | 317-944-5611 |
| MAILING | PO BOX 778912 | Chicago, IL 60677-8912 | 317-777-6435 |
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