Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 17153 | KY |
Y | 2086S0120X | Pediatric Surgery | 35-035616 | OH |
NPI | 1629075627 |
---|---|
Provider Name | Dr. Hirikati S Nagaraj |
First Address | Euclid, OH 44117-1714 |
Second Address | Cleveland, OH 44106-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 15/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1049646 | PASSPORT (01) | KY |
3120134 | (05) | OH |
64171531 | (05) | KY |
D18380 | (02) | KY |