Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 76179 | GA |
NPI | 1245529536 |
---|---|
Provider Name | Dr. Anton Shapoval |
First Address | Eden Prairie, MN 55344-5349 |
Second Address | Eden Prairie, MN 55344-5349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2011 |
Last Update Date | 03/02/2021 |