Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RP1001X | Pulmonary Disease | 0101254085 | VA |
Y | 207RP1001X | Pulmonary Disease | ME133652 | FL |
NPI | 1033379649 |
---|---|
Provider Name | Mr. Sanjiva Michael Lutchmedial |
First Address | Christiansburg, VA 24073 |
Second Address | Clearwater, FL 33756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2008 |
Last Update Date | 16/04/2019 |