Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 01063174 | IN |
NPI | 1023148939 |
---|---|
Provider Name | Thottathil Viswanathan Gopan |
First Address | Detroit, MI 48278-1076 |
Second Address | Munster, IN 46321-2899 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 26/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200858530 | (05) | IN |