Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 036142546 | IL |
NPI | 1013334556 |
---|---|
Provider Name | Mr. Sikarin Upala |
First Address | Mount Vernon, IL 62864-6296 |
Second Address | Mount Vernon, IL 62864 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2014 |
Last Update Date | 20/05/2019 |