Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 04-43416 | KS |
NPI | 1043625445 |
---|---|
Provider Name | Vidita Divan |
First Address | Topeka, KS 66604 |
Second Address | Topeka, KS 66606-2806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2014 |
Last Update Date | 13/10/2020 |