Individual
DR. SHASHI KEERTHAN MARYALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS
Contact information
Practice address
751 N RUTLEDGE ST, SPRINGFIELD, IL 62702-4968
(217) 545-8000
Mailing address
751 N RUTLEDGE ST, SPRINGFIELD, IL 62702-4968
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
125080004
IL
Other
Enumeration date
07/03/2022
Last updated
07/03/2022
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