Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 036106968 | IL |
NPI | 1013982578 |
---|---|
Provider Name | Shilpa Reddy Cherukupally |
First Address | Chicago, IL 60674-0018 |
Second Address | Lombard, IL 60148-4932 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 17/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036106968 | (05) | IL |