Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 12465 | ND |
NPI | 1154522746 |
---|---|
Provider Name | Prasad Jawahar Sawardeker |
First Address | Fargo, ND 58108-6001 |
Second Address | Fargo, ND 58103-6132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 10/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17137 | (05) | ND |