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General NPI Number Information
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NPI Number | 1598689341
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Entity Type | Individual
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Provider Name | AJAY GOUD NATTALA MBBS
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Gender | Male
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Dates
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Enumeration Date | 08/05/2026
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Last Update Date | 08/05/2026
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Provider Practice Location Address
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Address Line | 611 W PARK ST
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City | URBANA
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State | IL
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Zip | 61801-2529
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Country | US
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Telephone | 217-383-4633
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Fax |
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Provider Business Mailing Address
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Address Line | 1333 N LINCOLN AVE APT 2023
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City | URBANA
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State | IL
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Zip | 61801-1679
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Country | US
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Telephone | 217-202-5382
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 125.088959
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License Number State | IL
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