Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036150050 | IL |
N | 207X00000X | Orthopaedic Surgeon | 295309 | NY |
N | 207X00000X | Orthopaedic Surgeon | 60441 | CT |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036150050 | IL |
NPI | 1205280922 |
---|---|
Provider Name | Harish Kempegowda |
First Address | Marion, IL 62959-5897 |
Second Address | Marion, IL 62959 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2016 |
Last Update Date | 24/09/2019 |