Individual
BASANTI MUKERJI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5850 S 6TH STREET RD, SPRINGFIELD, IL 62703-5162
(217) 529-5046
(217) 529-6154
Mailing address
5850 S 6TH STREET RD, SPRINGFIELD, IL 62703-5162
(217) 529-5046
(217) 529-6154
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036060643
IL
207R00000X
Internal Medicine Physician
ME76732
FL
207RR0500X
Rheumatology Physician
Primary
036060643
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020057300
BLACK LUNG
IL
01
—
08421024
BC OF IL
IL
01
—
133586700
ACS-OWCP
IL
01
—
14D0435365
CLIA CFP
IL
01
—
14D0949277
CLIA PGW
IL
01
—
6394P
CATERPILLAR
IL
01
—
CD7143
RR MEDICARE GRP
IL
Enumeration date
01/24/2006
Last updated
04/26/2013
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