Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD00046193 | WA |
N | 2080P0214X | Pediatric Pulmonologist | MD00046193 | WA |
NPI | 1639129752 |
---|---|
Provider Name | Dr. Preetam Bandla |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Seattle, WA 98122-5788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 15/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1639129752 | (05) | WA |
H77261 | (02) |