Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 002494 | GA |
N | 207QA0505X | Family Doctor - Adult Medicine | MD.204015 | LA |
NPI | 1124257407 |
---|---|
Provider Name | Abhishek Agarwal |
First Address | Lake Charles, LA 70601-8824 |
Second Address | Roseville, CA 95661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2009 |
Last Update Date | 18/06/2018 |