Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 200200637 | NC |
Y | 207RC0000X | Internist - Cardiovascular Disease | 25067 | SC |
N | 207RI0011X | Interventional Cardiology | 200200637 | NC |
NPI | 1023093309 |
---|---|
Provider Name | Talal Tarak Baki |
First Address | Rock Hill, SC 29732 |
Second Address | Rock Hill, SC 29732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 27/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G16495 | (02) |