Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | J4719 | TX |
NPI | 1790745586 |
---|---|
Provider Name | Dr. Michael Joseph Biavati |
First Address | Dallas, TX 75231 |
Second Address | Dallas, TX 75231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F30145 | (02) |