Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 9701110 | NC |
N | 2086S0120X | Pediatric Surgery | 9701110 | NC |
N | 2086S0129X | Vascular Surgeon | 9701110 | NC |
NPI | 1144206749 |
---|---|
Provider Name | Thomas Pranikoff |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 12/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1066M | BCBS (01) | |
17510 | PARTNERS (01) | |
2005048000 | (05) | WV |
20051992 | RR MEDICARE (01) | |
5510597 | AETNA (01) | |
6724507 | (05) | VA |
74141 | MEDCOST (01) | |
891066M | (05) | NC |
F83260 | (02) | |
Q01110 | (05) | SC |