Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 35482 | IA |
NPI | 1033198395 |
---|---|
Provider Name | Dr. Manish G Kumar |
First Address | Bettendorf, IA 52722-3206 |
Second Address | Bettendorf, IA 52722-3206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 25/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0430967 | (05) | IA |