Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | J5651 | TX |
Y | 207RI0011X | Interventional Cardiology | J5651 | TX |
NPI | 1124090469 |
---|---|
Provider Name | Kennedy Thiagarajan |
First Address | Houston, TX 77002-9000 |
Second Address | Houston, TX 77002-9000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 17/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125031801 | (05) | TX |
G29939 | (02) | TX |