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General NPI Number Information
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NPI Number | 1255448460
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Entity Type | Organization
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Legal Business Name | USHASRI KOGANTI MDSC
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 11/19/2010
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Provider Practice Location Address
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Address Line | 1129 COLUMBUS ST
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City | OTTAWA
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State | IL
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Zip | 61350
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Country | US
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Telephone | 815-343-2048
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Fax | 815-434-2177
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Provider Business Mailing Address
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Address Line | 1129 COLUMBUS ST
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City | OTTAWA
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State | IL
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Zip | 61350
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Country | US
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Telephone | 815-343-2048
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Fax | 815-434-2177
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. USHASRI KOGANTI
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Credential | MD
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Telephone | 815-434-2048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-096808
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License Number State | IL
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