Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 35-071509 | OH |
NPI | 1023067428 |
---|---|
Provider Name | Trikannad S Prashanthkumar |
First Address | Sidney, OH 45365-2401 |
Second Address | Sidney, OH 45365-2401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 16/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2003852 | (05) | OH |
G44898 | (02) | OH |