Individual
HASANKI MADARA WARNAKULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-4940
Mailing address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-4940
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036165446
IL
208000000X
Pediatrics Physician
036165446
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/25/2020
Last updated
12/11/2023
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