Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 4243 | ND |
NPI | 1124127113 |
---|---|
Provider Name | Dr. Mylapanahalli Sanathanamurthy |
First Address | Bismarck, ND 58501-4516 |
Second Address | Bismarck, ND 58501-4516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 29/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1124127113 | NPI (01) | |
P00210736 | RAILROAD MEDICARE (01) | ND |