Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | K7277 | TX |
NPI | 1124082904 |
---|---|
Provider Name | John Michael Dimaio |
First Address | Plano, TX 75093-5339 |
Second Address | Plano, TX 75093 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 11/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
048545002 | (05) | TX |
G77590 | (02) |