Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 57098 | AZ |
NPI | 1043573017 |
---|---|
Provider Name | Mika Iwano |
First Address | Phoenix, AZ 85008-4973 |
Second Address | Buffalo, NY 14203-1009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2012 |
Last Update Date | 15/10/2021 |