Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 125050668 | IL |
NPI | 1003066630 |
---|---|
Provider Name | Meenakshi G Hegde |
First Address | Oak Park, IL 60302-4819 |
Second Address | Chicago, IL 60612-4325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2008 |
Last Update Date | 18/09/2008 |