Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 04-27506 | TN |
NPI | 1225035173 |
---|---|
Provider Name | Ram K Thinakkal |
First Address | Livingston, TN 38570-1879 |
Second Address | Livingston, TN 38570-1879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 18/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1509617 | (05) | TN |
C45342 | (02) | TN |