Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 125.077991 | IL |
Y | 111NI0900X | Internist | 125.077991 | IL |
NPI | 1003493735 |
---|---|
Provider Name | Suhana Elamsenthil |
First Address | Maywood, IL 60153-3328 |
Second Address | Maywood, IL 60153-3328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2021 |
Last Update Date | 01/06/2021 |