Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 019.032843 | IL |
Y | 213EG0000X | General Practice | 019.032843 | IL |
NPI | 1003421942 |
---|---|
Provider Name | Nitin Walia |
First Address | Naperville, IL 60565-6719 |
Second Address | Madison, WI 53717-2028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2020 |
Last Update Date | 08/09/2020 |