Healthcare Provider Details

I. General information

NPI: 1518039940
Provider Name (Legal Business Name): AARON JON LEGRAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 W SYCAMORE ST STE 200
KOKOMO IN
46901-5148
US

IV. Provider business mailing address

1907 W SYCAMORE ST # 200
KOKOMO IN
46901-5148
US

V. Phone/Fax

Practice location:
  • Phone: 765-236-8170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01059151A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: