Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 6421 | NV |
NPI | 1013008135 |
---|---|
Provider Name | Dr. Angelo W Kanellos |
First Address | Reno, NV 89511-3019 |
Second Address | Reno, NV 89521-8979 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 22/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0020-16386 | (05) | NV |
F28967 | (02) | NV |