Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036123894 | IL |
N | 111NI0900X | Internist | 036123894 | IL |
N | 207RC0000X | Internist - Cardiovascular Disease | MD15847 | HI |
Y | 207RC0000X | Internist - Cardiovascular Disease | N7294 | TX |
NPI | 1023064656 |
---|---|
Provider Name | Abhijeet V Koli |
First Address | Georgetown, TX 78626-7876 |
Second Address | Georgetown, TX 78626-7876 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1016296350001 | (05) | PA |