Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 01062836A | IN |
NPI | 1255415352 |
---|---|
Provider Name | Aydin T. Kizilisik |
First Address | Fort Wayne, IN 46804-7934 |
Second Address | Fort Wayne, IN 46804-4159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 27/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200861790 | (05) | IN |
H53982 | (02) |