Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | IN |
NPI | 1003895509 |
---|---|
Provider Name | Suhas V Kalghatgi |
First Address | Moline, IL 61265-4860 |
Second Address | Moline, IL 61265-4860 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H66981 | (02) |