Individual
VENKATESWARA P POOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS
Contact information
Practice address
315 W CARPENTER ST, 1ST FLOOR, SPRINGFIELD, IL 62702
(217) 545-8000
(217) 545-0952
Mailing address
PO BOX 19677, SPRINGFIELD, IL 62794-9677
(217) 545-8000
(217) 545-0952
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036-135600
IL
208C00000X
Colon & Rectal Surgery Physician
Primary
036-135600
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036135600
—
IL
Enumeration date
09/26/2008
Last updated
06/27/2018
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