Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | IL |
NPI | 1003833070 |
---|---|
Provider Name | Dr. Nitin Narendir Soorya |
First Address | Lake Geneva, WI 53147-2655 |
Second Address | Lake Geneva, WI 53147-2655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 26/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H34812 | (02) |