Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 59581 | AZ |
NPI | 1053750489 |
---|---|
Provider Name | Dr. Visish Mani Srinivasan |
First Address | Phoenix, AZ 85013-4409 |
Second Address | Houston, TX 77030-2400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2013 |
Last Update Date | 30/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005314 | (05) | AZ |