=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245824812
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NOAM ELIASHIV BARTUV MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2021
-----------------------------------------------------
Last Update Date | 02/24/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | # 1 PASTERNAK ST
-----------------------------------------------------
City | REHOVOT
-----------------------------------------------------
State | HAMERKAZ
-----------------------------------------------------
Zip | 7661041
-----------------------------------------------------
Country | IL
-----------------------------------------------------
Telephone | 972-894-4133
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | NACHAL GAMLA 8 APT 11
-----------------------------------------------------
City | KIRYAT ONO
-----------------------------------------------------
State | ISRAEL
-----------------------------------------------------
Zip | 55450
-----------------------------------------------------
Country | IL
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 40717
-----------------------------------------------------
License Number State | ZZ
-----------------------------------------------------