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General NPI Number Information
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NPI Number | 1538326582
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Entity Type | Organization
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Legal Business Name | KAUSHAL PEDIATRIC SERVICES LTD
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 4107 NORTH WATER TOWER PLACE
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City | MOUNT VERNON
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State | IL
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Zip | 62864
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Country | US
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Telephone | 618-242-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 4107 NORTH WATER TOWER PLACE
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City | MOUNT VERNON
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State | IL
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Zip | 62864
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Country | US
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Telephone | 618-242-5437
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NEETA B KAUSHAL
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Credential | M.D.
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Telephone | 618-204-0654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036094868
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License Number State | IL
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