Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD-45420 | IA |
Y | 2080P0203X | Pediatric Critical Care Doctor | MD-45420 | IA |
N | 2080P0203X | Pediatric Critical Care Doctor | ME113571 | FL |
NPI | 1104173103 |
---|---|
Provider Name | Madhuradhar Chegondi |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2012 |
Last Update Date | 24/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014922200 | (05) | FL |