Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | E3010 | AR |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 036117864 | IL |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 303313 | NY |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | E3010 | AR |
NPI | 1043228349 |
---|---|
Provider Name | Dr. Bulent Mamikoglu |
First Address | Peru, IL 61354-1193 |
Second Address | Wellsville, NY 14895-1150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 27/01/2022 |