Mamtani, Pushpa K

Mamtani, Pushpa K is an individual health care provider with primary practice located at 1614 E Norris Dr , Ottawa IL 61350-3681. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Mamtani, Pushpa K can be contacted via phone (815) 433-1010.

Contact Information

Primary practice address
1614 E Norris Dr Ottawa IL 61350-3681
Phone: (815) 433-1010
Fax: (815) 433-0067
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 36 064091 Illinois
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 4301503653 Michigan

Profile Details

NPI number 1376527168
LBN Legal business name Mamtani, Pushpa K
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 5th, 2005
Last updated Jan 25th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376527168 NPPES
Illinois MEDICAID 036064091
Illinois Other 01932040

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