Doctor Name: | ROSHAN DASARI |
NPI Number: | 1639387582 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.B.B.S. |
License Number: | 9406405 |
Business Practice Address: | 221 E State St Centerville, IA - 525441813 |
Business Phone Number: | 6418566471 |
Business Fax Number: | 6418562603 |
Mailing Address: | 221 E State St, CENTERVILLE |
State: | IA |
Postal Code: | 525441813 |
Phone Number: | 6418566471 |
Fax Number: | 6418562603 |
NPI Enumeration Date: | 05/21/2007 |
NPI Last Update Date: | 03/09/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 9406405 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | KS |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |