Organization
RK ILLANGO, MD, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAMANATHAN K ILLANGO MD (OWNER)
(614) 309-1265
Entity
Organization
Contact information
Practice address
719 W APACHE ST, FARMINGTON, NM 87401-5512
(614) 309-1265
Mailing address
719 W APACHE ST, FARMINGTON, NM 87401-5512
(614) 309-1265
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD2013-0749
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
XX
—
NM
Enumeration date
11/06/2017
Last updated
06/16/2018
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