Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 36067580 | IL |
NPI | 1205802071 |
---|---|
Provider Name | Rekha Agrawal |
First Address | Maywood, IL 60153 |
Second Address | Maywood, IL 60153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 02/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36067580 | (05) | IL |
C39323 | (02) |