Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036-085966 | IL |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 036-085966 | IL |
NPI | 1083637771 |
---|---|
Provider Name | Vishwanath Agrawal |
First Address | Naperville, IL 60563-2586 |
Second Address | Chicago, IL 60612-3714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 21/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55576 | (02) | IL |