Individual
MALLIKARJUNA R KANNEGANTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3001 GREEN BAY RD, NORTH CHICAGO, IL 60064-3048
(224) 610-3719
(224) 610-3824
Mailing address
3001 GREEN BAY RD, NORTH CHICAGO, IL 60064-3048
(224) 610-3719
(224) 610-3824
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
036078018
IL
Other
Enumeration date
06/16/2008
Last updated
06/18/2008
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