Individual
DR. WORLALI MOSES NUTAKOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2310 E MOUND RD, DECATUR, IL 62526-9640
(217) 877-0353
Mailing address
775 SPYGLASS BLVD, FORSYTH, IL 62535-9639
(217) 872-6134
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036103408
IL
207R00000X
Internal Medicine Physician
036103408
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036103408-1
—
IL
Enumeration date
08/31/2006
Last updated
01/04/2024
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