Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | IL |
NPI | 1023539988 |
---|---|
Provider Name | Mr. Rajajitendra Varma Vanapala |
First Address | Urbana, IL 61801 |
Second Address | Urbana, IL 61801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2017 |
Last Update Date | 30/06/2017 |