Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | 040551 | CT |
Y | 207RG0100X | Gastroenterologist | 64480 | AZ |
N | 207RG0100X | Gastroenterologist | ME102765 | FL |
NPI | 1033193891 |
---|---|
Provider Name | Dr. Shivakumar Vignesh |
First Address | Gilbert, AZ 85234 |
Second Address | Gilbert, AZ 85234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 28/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001405514 | (05) | CT |
H98792 | (02) |