Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 35-042001 | OH |
NPI | 1003893595 |
---|---|
Provider Name | Dr. Vijay G Mistry |
First Address | Mayfield Hts, OH 44124-2299 |
Second Address | Mayfield Hts, OH 44124-2299 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 05/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0432928 | (05) | OH |
0711064 | MEDICARE ID - TYPE UNSPECIFIED (01) | OH |
A14717 | (02) | OH |