Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 36107613 | IL |
NPI | 1023067311 |
---|---|
Provider Name | Dr. Vyjayanthi Atluri |
First Address | Chicago, IL 60674-8132 |
Second Address | Lombard, IL 60148-7029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2006 |
Last Update Date | 23/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
208342 | GROUP MEDICARE PTAN (01) | IL |
F100323989 | GROUP MEDICARE PTAN (01) | |
H79200 | (02) |