Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | IL |
NPI | 1063408698 |
---|---|
Provider Name | Hari K Agrawal |
First Address | Westmont, IL 60559-5511 |
Second Address | Chicago, IL 60629-1813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 22/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1619540 | BCBS PROVIDER ID (01) | IL |
D14414 | (02) | IL |