Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 20556 | IA |
NPI | 1508855222 |
---|---|
Provider Name | Dr. Pattaya Kullavan |
First Address | Cedar Rapids, IA 52402-5454 |
Second Address | Cedar Rapids, IA 52402-5454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0015446 | (05) | IA |
A14151 | (02) |