Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 10919 | ND |
Y | 207RH0003X | Hematology & Oncology | 23682 | NE |
NPI | 1043426034 |
---|---|
Provider Name | Amit Panwalkar |
First Address | Fargo, ND 58102-4539 |
Second Address | Fargo, ND 58102-4539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 27/04/2012 |