Basic Information
| Provider Information | |||||||||
| NPI: | 1497924278 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MYNA MEDICAL LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 388320 | ||||||||
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| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606388320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737678283 | ||||||||
| FaxNumber: | 7737678320 | ||||||||
| Practice Location | |||||||||
| Address1: | 5958 W LAWRENCE AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606303130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732833199 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2008 | ||||||||
| LastUpdateDate: | 02/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | NAGARAJU | ||||||||
| AuthorizedOfficialFirstName: | RAMALINGAPPA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7732833199 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M..D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.