Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 036124910 | IL |
Y | 208600000X | Surgeon | 036124910 | IL |
N | 208200000X | Surgeon | MD434356 | PA |
N | 208600000X | Surgeon | MD434356 | PA |
NPI | 1013174598 |
---|---|
Provider Name | Naresh Kumar Ahuja |
First Address | Herrin, IL 62948-3671 |
Second Address | Herrin, IL 62948-3671 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036124910 | (05) | IL |
3932056 | BCBS (01) | IL |
721089 | AETNA (01) | IL |