Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | 036-097724 | IL |
N | 207RI0200X | Infectious Disease | 036097724 | IL |
Y | 207RI0200X | Infectious Disease | 63995-20 | WI |
NPI | 1033187216 |
---|---|
Provider Name | Vijaya Somaraju |
First Address | Beloit, WI 53511-1842 |
Second Address | Beloit, WI 53511-1842 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 15/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036097724 | (05) | IL |
H18283 | (02) | IL |