Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 2019013099 | MO |
NPI | 1104267434 |
---|---|
Provider Name | Dr. Sathish Kumar Itikyala |
First Address | West Plains, MO 65775-4238 |
Second Address | West Plains, MO 65775-4238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2013 |
Last Update Date | 08/02/2022 |