Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 036046355 | IL |
NPI | 1073539680 |
---|---|
Provider Name | Dr. Rajalaxmi Mckenna |
First Address | Oak Lawn, IL 60453-4933 |
Second Address | Oak Lawn, IL 60453-4933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 30/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0031601474 | BLUE SHIELD (01) | IL |
036046355 | (05) | IL |
211195 | MEDICARE (01) | IL |
830004492 | RAILROAD MEDICARE (01) | |
D12605 | (02) |