Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 39939 | SC |
N | 2084N0400X | Neurologist | LL39939 | SC |
NPI | 1013460708 |
---|---|
Provider Name | Ketan Ramakant Jhunjhunwala |
First Address | Columbia, SC 29203 |
Second Address | Tampa, FL 33606-3438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2016 |
Last Update Date | 18/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
399394 | (05) | SC |
SCK3085019 | MEDICARE PIN (01) | SC |