Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 01028409A | IN |
N | 207RH0003X | Hematology & Oncology | 4301052476 | MI |
Y | 207RX0202X | Medical Oncology | 01028409A | IN |
NPI | 1013911593 |
---|---|
Provider Name | Rafat H Ansari |
First Address | South Bend, IN 46601-2349 |
Second Address | Mishawaka, IN 46545-1470 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 03/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000086654 | ANTHEM-BCBS (01) | IN |
100222840A | (05) | IN |
4795726 | (05) | MI |
D95753 | (02) |