Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 036-101008 | IL |
N | 207QA0401X | Family Doctor - Addiction Medicine | 036-101008 | IL |
NPI | 1548318488 |
---|---|
Provider Name | Dr. Preeti Vemuri |
First Address | Crystal Lake, IL 60014-6202 |
Second Address | Barrington, IL 60010-2396 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 28/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036101008 1 | (05) | IL |
H67926 | (02) |