Doctor Name: | RAJA C MADDIPOTI |
NPI Number: | 1215019328 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 036-082727 |
Business Practice Address: | 409 W Oak St Carbondale, IL - 629011414 |
Business Phone Number: | 6185294455 |
Business Fax Number: | 6183511287 |
Mailing Address: | Po Box 1105, INDIANAPOLIS |
State: | IN |
Postal Code: | 462061105 |
Phone Number: | 6185294455 |
Fax Number: | 6183511287 |
NPI Enumeration Date: | 10/19/2006 |
NPI Last Update Date: | 02/14/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 036-082727 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |