Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 2019002816 | MO |
Y | 207RP1001X | Pulmonary Disease | 2019002816 | MO |
NPI | 1043650542 |
---|---|
Provider Name | Dr. Shyam Shankar |
First Address | Kansas City, MO 64184-3966 |
Second Address | Colubmbia, MO 65212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2013 |
Last Update Date | 23/09/2019 |