Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD-46280 | IA |
N | 208600000X | Surgeon | MD-46280 | IA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD-46280 | IA |
NPI | 1053667220 |
---|---|
Provider Name | Dr. Yuichi Ishida |
First Address | Des Moines, IA 50305-1475 |
Second Address | Des Moines, IA 50314-3029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2012 |
Last Update Date | 26/09/2019 |