Individual
VIJAY LAXMI MISRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1228 TOWANDA AVE STE 1, BLOOMINGTON, IL 61701-3469
(309) 454-5900
(309) 454-2820
Mailing address
1228 TOWANDA AVE STE 1, BLOOMINGTON, IL 61701-3469
(309) 454-5900
(309) 454-2820
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036126566
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036126566
—
IL
Enumeration date
05/17/2006
Last updated
06/28/2024
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