Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 036084463 | IL |
NPI | 1023078797 |
---|---|
Provider Name | Deepak Malhotra |
First Address | Indianapolis, IN 46206-1105 |
Second Address | Carterville, IL 62918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2006 |
Last Update Date | 05/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G31395 | (02) | IL |