Individual
DR. JITHINRAJ EDAKKANAMBETH VARAYIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 W STATE ST, ROCKFORD, IL 61102
(815) 490-1600
(815) 490-1881
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125-067838
IL
207Q00000X
Family Medicine Physician
Primary
69874
MN
390200000X
Student in an Organized Health Care Education/Training Program
125-067838
IL
Other
Enumeration date
06/29/2015
Last updated
09/27/2021
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