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Individual

SHWETHA MANJUNATH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
036158938
IL
390200000X
Student in an Organized Health Care Education/Training Program
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
036158938
ILLINOIS STATE LICENSE
IL
Enumeration date
05/10/2017
Last updated
08/02/2022
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