Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 70412 | GA |
NPI | 1144458944 |
---|---|
Provider Name | Irshan A Rajput |
First Address | Augusta, GA 30912-0004 |
Second Address | Peoria, IL 61637-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2009 |
Last Update Date | 19/08/2015 |