Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 04-31638 | KS |
N | 207K00000X | Allergist & Immunologist | 13206 | ND |
N | 207R00000X | Internist | 04-31638 | KS |
N | 111NI0900X | Internist | 04-31638 | KS |
Y | 207RA0201X | Internist - Allergy & Immunology | 13206 | ND |
NPI | 1962457598 |
---|---|
Provider Name | Dr. Saakwa Mante |
First Address | Fargo, ND 58103-4940 |
Second Address | Fargo, ND 58103-4940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 23/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1457334 | (05) | ND |
200367290A | (05) | KS |
F88794 | (02) |