Individual
PRAVEEN K MULLANGI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 N 8TH ST, SPRINGFIELD, IL 62701-1041
(217) 528-7541
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
036120667
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036120667
—
IL
01
—
R02610
MEDICARE PTAN
IL
Enumeration date
07/31/2007
Last updated
05/21/2020
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