Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 44850 | TN |
Y | 208600000X | Surgeon | 44850 | TN |
NPI | 1013901784 |
---|---|
Provider Name | Mark H Kadowaki |
First Address | Kingsport, TN 37660-4632 |
Second Address | Kingsport, TN 37660-3816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 10/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013901784 | (05) | VA |
4238238 | BLUE CROSS TENNESSEE (01) | TN |
D15746 | (02) |