Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036135787 | IL |
N | 111NI0900X | Internist | 036135787 | IL |
N | 207R00000X | Internist | 125059036 | IL |
N | 111NI0900X | Internist | 125059036 | IL |
N | 207RC0000X | Internist - Cardiovascular Disease | 036.135787 | IL |
Y | 207RI0011X | Interventional Cardiology | 036.135787 | IL |
NPI | 1003104605 |
---|---|
Provider Name | Preetham Reddy Muskula |
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 | 16/07/2011 |
Last Update Date | 21/12/2021 |