Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 02003289A | IN |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 02003289A | IN |
NPI | 1205841913 |
---|---|
Provider Name | Ritu Rohatgi |
First Address | Chicago, IL 60677-5383 |
Second Address | Columbus, IN 47203-2036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 30/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000991447 | ANTHEM PIN (01) | IN |
200918650 | (05) | IN |
I07864 | (02) | MI |