Individual
KAVANTISSA MONARAWILA KEPPETIPOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 S PAULINA ST, CHICAGO, IL 60612-3806
(312) 942-7100
Mailing address
600 S PAULINA ST, CHICAGO, IL 60612-3806
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
113510
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/06/2019
Last updated
06/24/2026
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