Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 01062446A | IN |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 036-116812 | IL |
N | 2081P2900X | Pain Medicine | 036116812 | IL |
NPI | 1164505392 |
---|---|
Provider Name | Swathi Mothkur |
First Address | La Porte, IN 46352-1690 |
Second Address | Chicago, IL 60625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 11/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200974280 | (05) | IN |
I64612 | (02) | IN |