Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 2005015816 | MO |
NPI | 1073729695 |
---|---|
Provider Name | Dr. Kartik Deepak Nettar |
First Address | Pasadena, CA 91188-0001 |
Second Address | Saint Louis, MO 63110-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 04/11/2021 |