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NPI Code Detail

MEDICARE: MR. NARESH NEKKANTI M.D

MEDICARE: MR. NARESH NEKKANTI M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program125057401IL
2207Q00000XFamily Medicine Physician036131081IL

General Provider Information

NPI Number : 1366762759
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NARESH NEKKANTI M.D
Provider Business Mailing Address
First Line : 8135 CALUMET AVE
Second Line :
City : MUNSTER
State : IN
Zip : 46321-1701
Country : US
Telephone Number : 219-513-2000
Fax Number :
Provider Business Practice Location Address
First Line : 2512 HURST DR
Second Line : STE 120
City : MATTOON
State : IL
Zip : 61938-9200
Country : US
Telephone Number : 217-258-7590
Fax Number : 217-258-3686
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2010
Last Update Date : 03/16/2021

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