Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 43108 | AZ |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 43108 | AZ |
NPI | 1104984491 |
---|---|
Provider Name | Kishlay Anand |
First Address | Phoenix, AZ 85080-1638 |
Second Address | Surprise, AZ 85378-9021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 29/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
514574 | AHCCCS (01) | AZ |