Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 036109706 | IL |
NPI | 1053443895 |
---|---|
Provider Name | Priyadarshini Verma |
First Address | Aurora, IL 60506-6222 |
Second Address | Aurora, IL 60506-6209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 18/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036109706 | (05) | IL |
04515143 | BCBS# (01) | IL |