Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD17393 | HI |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD472279 | PA |
NPI | 1003178617 |
---|---|
Provider Name | Dr. Anthony Michael Tolisano |
First Address | Dallas, TX 75390-9035 |
Second Address | Dallas, TX 75390-5001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2012 |
Last Update Date | 04/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) |