Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 052337 | CT |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 052337 | CT |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 052337 | CT |
NPI | 1639483522 |
---|---|
Provider Name | Dr. Vivek Jagadale |
First Address | Little Rock, AR 72205-5446 |
Second Address | Little Rock, AR 72205-5446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2010 |
Last Update Date | 13/06/2019 |