Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 036-095726 | IL |
Y | 207RC0000X | Internist - Cardiovascular Disease | 036095726 | IL |
NPI | 1427130426 |
---|---|
Provider Name | Nasaraiah Nallamothu |
First Address | Springfield, IL 62701-1034 |
Second Address | Springfield, IL 62701-1034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036095726 | (05) | IL |
060041893 | RAILROAD (01) | IL |
G54849 | (02) | IL |