Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 12012186A | IN |
NPI | 1003222514 |
---|---|
Provider Name | Ganapathy Manjunath |
First Address | Schaumburg, IL 60173-4166 |
Second Address | Schaumburg, IL 60173-4166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2014 |
Last Update Date | 03/07/2014 |