Individual
DR. SAMUEL K APPAVU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2300 N ROCKTON AVE, STE 304, ROCKFORD, IL 61103-3619
(815) 964-3333
(815) 964-3134
Mailing address
PO BOX 15730, LOVES PARK, IL 61132-5730
(815) 964-3333
(815) 964-3134
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
036048085
IL
208600000X
Surgery Physician
Primary
036048085
IL
2086S0102X
Surgical Critical Care Physician
036048085
IL
2086S0127X
Trauma Surgery Physician
036048085
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036048085
STATE LICENSE
IL
05
—
036048085 1
—
IL
01
—
194281
PERSONAL CARE
—
01
—
204575400
OWCP
IL
Enumeration date
05/24/2005
Last updated
03/02/2011
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