Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 036091129 | IL |
Y | 207R00000X | Internist | 036-091129 | IL |
Y | 111NI0900X | Internist | 036-091129 | IL |
N | 207RA0401X | Internist - Addiction Medicine | 036091129 | IL |
NPI | 1730170655 |
---|---|
Provider Name | Dr. Narain D Mandhan |
First Address | Monticello, IL 61856-2116 |
Second Address | Monticello, IL 61856-2116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 11/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036091129 | (05) | IL |
G13912 | (02) | IL |