Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 036157561 | IL |
NPI | 1033464698 |
---|---|
Provider Name | Ratnam Kolluru Nookala Santoshi |
First Address | Springfield, IL 62794-9248 |
Second Address | Springfield, IL 62781-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2012 |
Last Update Date | 10/11/2021 |