Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | R2744 | TX |
Y | 111NI0900X | Internist | R2744 | TX |
NPI | 1003217977 |
---|---|
Provider Name | Mikhail Shipotko |
First Address | Corpus Christi, TX 78466-0465 |
Second Address | Corpus Christi, TX 78411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2014 |
Last Update Date | 11/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
370615201 | (05) | TX |