Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | E-10634 | AR |
NPI | 1083001382 |
---|---|
Provider Name | Tanmay Anant Bhamare |
First Address | Little Rock, AR 72205-7101 |
Second Address | Little Rock, AR 72205-7101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2015 |
Last Update Date | 07/07/2017 |