Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 4301114422 | MI |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD-46204 | IA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD-46204 | IA |
NPI | 1699068122 |
---|---|
Provider Name | Marisa Rae Buchakjian |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2011 |
Last Update Date | 15/07/2019 |