=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740266998
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VISHWANATHA S NADIG MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2005
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 E COLLIN RAYE DR STE C
-----------------------------------------------------
City | DE QUEEN
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-642-5323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 405 E COLLIN RAYE DR STE C
-----------------------------------------------------
City | DE QUEEN
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71832-4107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-642-5323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | 04-34837
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | 28667
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | 0101268888
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | E-11030
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------