Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | IL |
NPI | 1487633087 |
---|---|
Provider Name | Dr. Mohana R Velagapudi |
First Address | Moline, IL 61265-6138 |
Second Address | Moline, IL 61265-6138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C48966 | (02) |