Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | ME79108 | FL |
NPI | 1093091225 |
---|---|
Provider Name | Dr. Mohan Thanikachalam |
First Address | Columbus, OH 43209 |
Second Address | Columbus, OH 43209-1430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2011 |
Last Update Date | 02/11/2011 |