PUSHPA K MAMTANI

ROCKFORD, IL
NPI1376527168
Former NamePUSHPA BALASUBRAMANIAN
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy208000000X Pediatrics
(Licence: IL  36 064091)
Additional Taxonomies208000000X Pediatrics
(Licence: MI  4301503653)
Enumeration Date2005-12-05
Last Update Date2025-03-05
Business Address
PUSHPA K MAMTANI MD
5666 E STATE ST
ROCKFORD, IL 61108-2425
Phone number: 815-226-2000
Mailing Address
PUSHPA K MAMTANI MD
5666 E STATE ST
ROCKFORD, IL 61108-2425
Phone number: 815-226-2000