Provider Demographics
NPI:1518959329
Name:SEKHARAN, MATHANGI R (MD)
Entity type:Individual
Prefix:
First Name:MATHANGI
Middle Name:R
Last Name:SEKHARAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:103 S GREENLEAF ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3380
Mailing Address - Country:US
Mailing Address - Phone:847-623-5855
Mailing Address - Fax:847-623-6166
Practice Address - Street 1:103 S GREENLEAF ST
Practice Address - Street 2:SUITE A
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3380
Practice Address - Country:US
Practice Address - Phone:847-623-5855
Practice Address - Fax:847-623-6166
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036089529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG10368Medicare UPIN