Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | DR.0065508 | CO |
NPI | 1356417919 |
---|---|
Provider Name | Dr. Suresh Rajamanickam |
First Address | Austin, TX 78731-4280 |
Second Address | Wellington, FL 33414-9325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 16/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
264775300 | (05) | FL |
G44790 | (02) | FL |