Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 036063062 | IL |
NPI | 1043200835 |
---|---|
Provider Name | Bavikatte N Shivakumar |
First Address | Davenport, IA 52807-3480 |
Second Address | Davenport, IA 52807-3480 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 25/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B18009 | (02) |