Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | 19482 | NE |
N | 207RA0201X | Internist - Allergy & Immunology | 37760 | CO |
Y | 207RA0201X | Internist - Allergy & Immunology | 4234A | WY |
NPI | 1831171891 |
---|---|
Provider Name | Lakhman L Gondalia |
First Address | Cheyenne, WY 82009-3432 |
Second Address | Cheyenne, WY 82009-3432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 20/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030005402 | MEDICARE RR (01) | |
10024964200 | (05) | NE |
118095901 | (05) | WY |
D93762 | (02) |