Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 57.020709 | OH |
NPI | 1073860284 |
---|---|
Provider Name | Dr. George Habanbo |
First Address | Cleveland, OH 44102-1705 |
Second Address | Cleveland, OH 44102-1705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2012 |
Last Update Date | 07/08/2012 |