Individual
MASTAN RAO INDLAMURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.,
Contact information
Practice address
2239 E COOK ST, SPRINGFIELD, IL 62703-1944
(713) 500-7616
(713) 500-7619
Mailing address
2239 E COOK ST, SPRINGFIELD, IL 62703-1944
(217) 788-2300
(217) 788-2342
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036.142622
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036142622
—
IL
Enumeration date
07/22/2013
Last updated
02/12/2018
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