Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 125067793 | IL |
NPI | 1043693807 |
---|---|
Provider Name | Dr. Ravi Nunna |
First Address | Chicago, IL 60612-3800 |
Second Address | Chicago, IL 60612-3800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2015 |
Last Update Date | 29/06/2015 |