Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0208X | Pediatric Infectious Diseases | 01065535A | IN |
Y | 2080P0214X | Pediatric Pulmonologist | 01065535A | IN |
NPI | 1053387175 |
---|---|
Provider Name | Asad Ansari |
First Address | South Bend, IN 46617-1924 |
Second Address | South Bend, IN 46601-1169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200928890 | (05) | IN |
H32298 | (02) | SD |