Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125054079 | IL |
N | 111NI0900X | Internist | 125054079 | IL |
Y | 207RC0000X | Internist - Cardiovascular Disease | MD31925 | AL |
NPI | 1013224609 |
---|---|
Provider Name | Dr. Shyam Padmanabhan |
First Address | Montgomery, AL 36116-2004 |
Second Address | Montgomery, AL 36116-2004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2010 |
Last Update Date | 12/09/2017 |