Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 6974 | TX |
NPI | 1548354772 |
---|---|
Provider Name | Dr. Miguel Chiusano |
First Address | Mansfield, TX 76063-0010 |
Second Address | Arlington, TX 76018-5260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U64220 | (02) | TX |