Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 34312 | IA |
N | 207QA0505X | Family Doctor - Adult Medicine | 21889 | NE |
NPI | 1033295308 |
---|---|
Provider Name | Takashi Kawamitsu |
First Address | Omaha, NE 68103-0755 |
Second Address | Council Bluffs, IA 51503-4658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 14/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
075120015 | (02) | IA |
1033295308 | (05) | IA |
47068731712 | (05) | NE |
H74955 | (02) |