Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 59144 | AZ |
Y | 111NI0900X | Internist | 59144 | AZ |
N | 207RC0000X | Internist - Cardiovascular Disease | 59144 | AZ |
N | 207RN0300X | Nephrologist | 59144 | AZ |
NPI | 1023470879 |
---|---|
Provider Name | Suman Misra |
First Address | Phoenix, AZ 85012-2716 |
Second Address | Phoenix, AZ 85013-4223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 20/10/2020 |