Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 35044638S | OH |
NPI | 1023114154 |
---|---|
Provider Name | Hullukunte Bylappa Shivaprasad |
First Address | Portsmouth, OH 45662 |
Second Address | Portsmouth, OH 45662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 18/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0464788 | (05) | OH |
64114994 | (05) | KY |
A80350 | (02) |