Individual
DR. KOUSIKI PATRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1653 W CONGRESS PKWY, MURDOCK 622, CHICAGO, IL 60612-3833
(312) 942-6640
(312) 942-4370
Mailing address
1653 W CONGRESS PKWY, MURDOCK 622, CHICAGO, IL 60612-3833
(312) 942-6640
(312) 942-4370
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
35077993
OH
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
35077993
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2317193
—
OH
Enumeration date
10/18/2005
Last updated
06/13/2011
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