Individual
DR. NICKY MAHBOOB WADIWALA
Active
Individual
DR. NICKY MAHBOOB WADIWALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
20A11280
CA
207RC0000X
Cardiovascular Disease Physician
Primary
20A11280
CA
207RI0011X
Interventional Cardiology Physician
20A11280
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0082854
—
OH
01
—
H198010
MEDICARE PTAN
OH
Enumeration date
06/25/2010
Last updated
05/08/2017
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