Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 036088953 | IL |
NPI | 1093774465 |
---|---|
Provider Name | Parameswaren Venugopal |
First Address | Chicago, IL 60612-3841 |
Second Address | Chicago, IL 60612-3841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 14/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G55582 | (02) | IL |