Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | MD40424 | TN |
Y | 207RH0003X | Hematology & Oncology | 01077437A | IN |
NPI | 1124102231 |
---|---|
Provider Name | Utpal P Dave |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 13/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201388130 | (05) | IN |
I46528 | (02) |