Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 036-111493 | IL |
NPI | 1205096963 |
---|---|
Provider Name | Rani Ganesan |
First Address | Chicago, IL 60612-3833 |
Second Address | Chicago, IL 60612-3833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2008 |
Last Update Date | 16/06/2008 |