Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 36 002104 | OH |
NPI | 1073511473 |
---|---|
Provider Name | Mitchell Dalvin |
First Address | Austintown, OH 44515-4703 |
Second Address | Austintown, OH 44515-4703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2005 |
Last Update Date | 12/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0519442 | (05) | OH |
T80545 | (02) | OH |