Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 01024272A | IN |
NPI | 1437420296 |
---|---|
Provider Name | Enayat K Shirazi |
First Address | Richmond, IN 47374-7826 |
Second Address | Richmond, IN 47374-7826 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2012 |
Last Update Date | 25/01/2012 |