Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 2982 | IA |
NPI | 1013013853 |
---|---|
Provider Name | Myles Kawamura |
First Address | Des Moines, IA 50305-4925 |
Second Address | Des Moines, IA 50314-2610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 26/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2132506 | (05) | IA |
G18476 | (02) | IA |