Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 1013 | MN |
N | 207RC0000X | Internist - Cardiovascular Disease | L3392SP | AL |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | L3392SP | AL |
NPI | 1205135381 |
---|---|
Provider Name | Takumi Yamada |
First Address | Birmingham, AL 35255-5310 |
Second Address | Minneapolis, MN 55454-1450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2011 |
Last Update Date | 24/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051114167 | BCBS OF AL (01) | |
051114193 | BCBS OF AL (01) | AL |
051114194 | BCBS OF AL (01) | AL |
06430523 | (05) | MS |
125848 | (05) | AL |
125854 | (05) | AL |
125857 | (05) | AL |
Z21078 | VIVA (01) |