Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | 036128611 | IL |
Y | 207RI0200X | Infectious Disease | 4301104040 | MI |
NPI | 1083805469 |
---|---|
Provider Name | Dr. Manju Shivan Haridas |
First Address | Tampa, FL 33614-7113 |
Second Address | Tampa, FL 33614-7113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2007 |
Last Update Date | 14/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0F39573 | BLUE CROSS (01) | MI |