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General NPI Number Information
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NPI Number | 1497268015
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Entity Type | Organization
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Legal Business Name | RK ILLANGO, MD, INC
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Dates
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Enumeration Date | 11/06/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 719 W APACHE ST
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City | FARMINGTON
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State | NM
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Zip | 87401-5512
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Country | US
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Telephone | 614-309-1265
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Fax |
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Provider Business Mailing Address
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Address Line | 719 W APACHE ST
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City | FARMINGTON
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State | NM
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Zip | 87401-5512
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Country | US
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Telephone | 614-309-1265
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAMANATHAN K ILLANGO
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Credential | MD
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Telephone | 614-309-1265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD2013-0749
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License Number State | NM
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