Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | BP10037503 | TX |
N | 111NI0900X | Internist | BP10037503 | TX |
N | 207RH0003X | Hematology & Oncology | 64330 | WI |
Y | 207RH0003X | Hematology & Oncology | MD60707157 | WA |
N | 207RX0202X | Medical Oncology | 48381 | KY |
N | 207RX0202X | Medical Oncology | 64330 | WI |
NPI | 1073822235 |
---|---|
Provider Name | Dr. Siva Krishna Mannem |
First Address | Yakima, WA 98902-6388 |
Second Address | Yakima, WA 98902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2010 |
Last Update Date | 07/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2072035 | (05) | WA |