Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 35.133073 | OH |
Y | 111NI0900X | Internist | 35.133073 | OH |
NPI | 1003296591 |
---|---|
Provider Name | Komal Tariq |
First Address | Miamisburg, OH 45343-0229 |
Second Address | Middletown, OH 45005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2015 |
Last Update Date | 19/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0300858 | (05) | OH |
7100557280 | (05) | KY |