Organization
AMKY MSO-1 PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YUGANDHAR KANDIMALLA MD (PRESIDENT)
(678) 982-3590
Entity
Organization
Contact information
Practice address
1325 W WHITTAKER ST STE D, SALEM, IL 62881-2034
(678) 982-3590
Mailing address
1325 W WHITTAKER ST STE D, SALEM, IL 62881-2034
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
10/09/2024
Last updated
11/20/2024
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