Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 107201 | MN |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 107201 | MN |
NPI | 1205035961 |
---|---|
Provider Name | Dr. Luciano Costa Amado |
First Address | Edina, MN 55435-2163 |
Second Address | Edina, MN 55435-2163 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2007 |
Last Update Date | 27/09/2013 |