=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326043282
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NARCISA CODRUTA GERMAN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2005
-----------------------------------------------------
Last Update Date | 12/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2605 E CREEKS EDGE DR
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47401-8368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-355-6582
-----------------------------------------------------
Fax | 812-355-2319
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 S LANDMARK AVE
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47403-3239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-355-6582
-----------------------------------------------------
Fax | 812-355-2319
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 01060727A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------