Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 1003221482 | OH |
Y | 207P00000X | Emergency Physician | 83340 | GA |
NPI | 1003221482 |
---|---|
Provider Name | Kushal Nandam |
First Address | Columbus, OH 43212-2201 |
Second Address | Columbus, OH 43210-1280 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2014 |
Last Update Date | 10/07/2019 |