Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 01047786A | IN |
NPI | 1043266174 |
---|---|
Provider Name | Mian Mushtaq |
First Address | Louisville, KY 40202-3700 |
Second Address | Jeffersonville, IN 47130-3764 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200437800 | (05) | IN |
64053093 | (05) | KY |