Individual
PRASANTA BHAMIDIPATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
301 N 8TH ST, SUITE PAV 4A, SPRINGFIELD, IL 62701-1041
(217) 545-8000
(217) 545-0130
Mailing address
301 N 8TH ST, PO BOX 19658, SPRINGFIELD, IL 62701-1041
(217) 545-8000
(217) 545-0130
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036126754
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036126754
—
IL
Enumeration date
10/15/2010
Last updated
03/11/2015
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