Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 036095233 | IL |
NPI | 1043207251 |
---|---|
Provider Name | Dr. Rajini Manjunath |
First Address | Chicago, IL 60673-2150 |
Second Address | Elgin, IL 60123-9400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036095233 | (05) | IL |
H17436 | (02) | IL |