Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 11017478A | IN |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 11017478A | IN |
NPI | 1225464324 |
---|---|
Provider Name | Halkawt Ali Nuri |
First Address | Indianapolis, IN 46202-5112 |
Second Address | Indianapolis, IN 46202-5112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2013 |
Last Update Date | 20/09/2013 |