Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 28647 | IA |
N | 208000000X | Pediatrician | MD-28647 | IA |
NPI | 1801881685 |
---|---|
Provider Name | Hatem I El-Shanti |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 25/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1092437 | (05) | IA |
46385 | WELLMARK BCBS (01) | IA |
F35204 | (02) |