Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
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NPI 1083743397

Individual provider · NPI 1083743397 Deactivated

This NPI was deactivated on September 10, 2026. The record is kept for reference and should not be used for billing or referrals.

NPI 1083743397 is listed in the national NPI registry.

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Record details

NPI number1083743397
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—