Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 264773 | MA |
N | 111NI0900X | Internist | 264773 | MA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 01086012A | IN |
NPI | 1265815229 |
---|---|
Provider Name | Mansour Almnajam |
First Address | Indianapolis, IN 46202-1218 |
Second Address | Indianapolis, IN 46202-1218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2015 |
Last Update Date | 17/06/2021 |