Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 01075003A | IN |
N | 207V00000X | Obstetrician & Gynecologist | 050379 | CT |
N | 207VG0400X | Gynecologist | 050379 | CT |
NPI | 1073714549 |
---|---|
Provider Name | Zhiquan Zhao |
First Address | South Bend, IN 46617-2057 |
Second Address | South Bend, IN 46635-1479 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 14/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000934242 | BCBS HOSP (01) | IN |
000000934270 | BCBS FMC (01) | IN |
1073714549 | (05) | CT |
201279260 | (05) | IN |