Individual
DR. ASHA S MUTHALALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
903 N 129TH INFANTRY DR, SUITE 600, JOLIET, IL 60435-3171
(815) 744-7246
(815) 744-7346
Mailing address
903 N 129TH INFANTRY DR, SUITE 600, JOLIET, IL 60435-3171
(815) 744-7246
(815) 744-7346
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
036123531
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036123531
—
IL
01
—
205574037
MEDICARE ID
IL
01
—
213382
GROUP PTAN
IL
Enumeration date
05/09/2008
Last updated
11/08/2014
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