Individual
SALUJA KAUSHALI MAHABAMUNUGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153
(708) 216-3280
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-3280
Taxonomy
Speciality
Code
Description
License number
State
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
000000000
GA
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
135.001069
IL
Other
Enumeration date
07/11/2018
Last updated
09/29/2019
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