Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 000000000 | GA |
Y | 213ES0103X | Foot & Ankle Surgery | 135.001069 | IL |
NPI | 1497231518 |
---|---|
Provider Name | Saluja Kaushali Mahabamunuge |
First Address | Maywood, IL 60153-3328 |
Second Address | Maywood, IL 60153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2018 |
Last Update Date | 29/09/2019 |