DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: PUSHPA K MAMTANI MD

MEDICARE: PUSHPA K MAMTANI MD
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
1208000000XPediatrics Physician4301503653MI
2208000000XPediatrics Physician36 064091IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101932040OTHERILBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376527168
Entity Type Code : Individual
Provider Name (Legal Business Name) : PUSHPA K MAMTANI MD
Provider Business Mailing Address
First Line : 5666 E STATE ST
Second Line :
City : ROCKFORD
State : IL
Zip : 61108-2425
Country : US
Telephone Number : 815-226-2000
Fax Number :
Provider Business Practice Location Address
First Line : 5666 E STATE ST
Second Line :
City : ROCKFORD
State : IL
Zip : 61108-2425
Country : US
Telephone Number : 815-226-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2005
Last Update Date : 03/05/2025

Similar Medicare Providers

1578276051 — TRACY EAKLE APRN
Practice Location Address:
5666 E STATE ST
ROCKFORD, IL
61108-2425
Practice Phone: 815-226-2000
Practice Fax:
1275686891 — DR. SUJIT PRASAD SHRESTHA M.D.
Practice Location Address:
5666 E STATE ST
ROCKFORD, IL
61108-2425
Practice Phone: 815-226-2000
Practice Fax:
1902546963 — ROBERT A LARSON DO
Practice Location Address:
5666 E STATE ST
ROCKFORD, IL
61108-2425
Practice Phone: 815-519-6087
Practice Fax:
1881674299 — DAVID LAIB MD
Practice Location Address:
5666 E STATE ST
ROCKFORD, IL
61108-2425
Practice Phone: 815-395-5108
Practice Fax:
1861462616 — DR. LISA A DAVIS M.D.
Practice Location Address:
5666 E STATE ST
ROCKFORD, IL
61108-2425
Practice Phone: 815-226-2000
Practice Fax:
1043280811 — CHRISTOPHER M. NIELSEN M.D.
Practice Location Address:
5666 EAST STATE STREET
ROCKFORD, IL
61108-2425
Practice Phone: 815-226-2000
Practice Fax: 608-826-2710

Directions to “ PUSHPA K MAMTANI MD” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.