Individual
LOKANATHAM GUMIDYALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 N COLLEGE AVE, GENESEO, IL 61254-1091
(309) 944-6431
Mailing address
600 N COLLEGE AVE, GENESEO, IL 61254-1091
(309) 944-6431
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
36063714
IL
207P00000X
Emergency Medicine Physician
Primary
45766
KY
207P00000X
Emergency Medicine Physician
N2099
TX
Other
Enumeration date
08/20/2006
Last updated
04/25/2013
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