Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 036116634 | IL |
NPI | 1023217551 |
---|---|
Provider Name | Kumarpal Shrishrimal |
First Address | Peoria, IL 61603-3112 |
Second Address | Bloomington, IL 61701-7904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2007 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-116634 | (05) | IL |
613790003 | UPIN (01) | IL |