Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 036-106018 | IL |
NPI | 1013091032 |
---|---|
Provider Name | Jhansi Raju |
First Address | Chicago, IL 60623-3824 |
Second Address | Chicago, IL 60623-3824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 14/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H75362 | (02) |