Individual
MANOGNA NOOKATHOTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 529-0479
Mailing address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 529-0479
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
7329
NE
207R00000X
Internal Medicine Physician
Primary
MD2022-0086
NM
208M00000X
Hospitalist Physician
036143222
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
MULTISPECIALTY GROUP PTAN
IL
Enumeration date
07/05/2014
Last updated
02/09/2024
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