Individual
SOMBABU N MAGANTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
2115 S FREMONT AVE, STE 3000, SPRINGFIELD, MO 65804-2239
(417) 820-3911
(417) 820-3924
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
2011022935
MO
2084N0600X
Clinical Neurophysiology Physician
25MA08817500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407142474
—
MO
05
—
188731001
—
AR
01
—
P00990413
RR MCR
MO
Enumeration date
06/28/2011
Last updated
03/20/2012
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