Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | Q1876 | TX |
NPI | 1104112143 |
---|---|
Provider Name | Poornima Pandiyan |
First Address | Wichita, KS 67214 |
Second Address | Wichita, KS 67214-4910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2011 |
Last Update Date | 25/08/2017 |