Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 0431284 | KS |
NPI | 1073512422 |
---|---|
Provider Name | Dr. Philip F Bongiorno |
First Address | Topeka, KS 66601-1657 |
Second Address | Topeka, KS 66606-1684 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 08/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200326220A | (05) | KS |
H02401 | (02) | KS |