Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | 04-39416 | KS |
N | 2080P0202X | Pediatric Cardiologist | 2016032920 | MO |
N | 2080P0202X | Pediatric Cardiologist | 37499 | IA |
Y | 2080P0202X | Pediatric Cardiologist | DR.0057261 | CO |
NPI | 1215125208 |
---|---|
Provider Name | Dr. Abhay Ashok Divekar |
First Address | Dallas, TX 75390-9063 |
Second Address | Dallas, TX 75390-9063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2007 |
Last Update Date | 12/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
71365 | WELLMARK BCBS (01) | IA |