Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 125-054774 | IL |
NPI | 1467601583 |
---|---|
Provider Name | Muthuswamy Dhiwakar |
First Address | Springfield, IL 62794-9656 |
Second Address | Springfield, IL 62701-1041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2008 |
Last Update Date | 20/10/2008 |