Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 35.097422 | OH |
N | 2080P0202X | Pediatric Cardiologist | 01079115 | IN |
Y | 2080P0202X | Pediatric Cardiologist | 01079115A | IN |
N | 2080P0202X | Pediatric Cardiologist | 35.097422 | OH |
NPI | 1124250915 |
---|---|
Provider Name | Vimal Jayswal |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Fort Wayne, IN 46845-1707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2009 |
Last Update Date | 01/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0102438 | (05) | OH |