Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 11013193A | IN |
N | 2086S0105X | Surgery of the Hand | 40203 | KY |
NPI | 1063543700 |
---|---|
Provider Name | Bardia Amirlak |
First Address | Jeffersonville, IN 47130-3210 |
Second Address | Jeffersonville, IN 47130-3210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |