Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 65892 | WI |
N | 208000000X | Pediatrician | 125059150 | IL |
NPI | 1154616795 |
---|---|
Provider Name | Dr. Ashvini Varadhi Biswas |
First Address | Kenosha, WI 53142-7884 |
Second Address | Kenosha, WI 53142-7884 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2011 |
Last Update Date | 23/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100062488 | (05) | WI |