Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | 04-32774 | KS |
Y | 2080P0202X | Pediatric Cardiologist | 2007026050 | MO |
NPI | 1194920918 |
---|---|
Provider Name | Svjetlana Tisma-Dupanovic |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 30/03/2015 |