Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 35.050695 | OH |
NPI | 1477636850 |
---|---|
Provider Name | Dr. Renuka Diwan |
First Address | Westlake, OH 44145-1785 |
Second Address | Westlake, OH 44145-5270 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E27513 | (02) | OH |