| Ushasri Koganti Mdsc | |
|
1129 Columbus St Ottawa IL 61350 | |
| (815) 343-2048 | |
| (815) 434-2177 |
| Full Name | Ushasri Koganti Mdsc |
|---|---|
| Speciality | Family Medicine |
| Location | 1129 Columbus St, Ottawa, Illinois |
| Authorized Official Name and Position | Ushasri Koganti (PHYSICIAN) |
| Authorized Official Contact | 8154342048 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ushasri Koganti Mdsc 1129 Columbus St Ottawa IL 61350 Ph: (815) 343-2048 | Ushasri Koganti Mdsc 1129 Columbus St Ottawa IL 61350 Ph: (815) 343-2048 |
| NPI Number | 1255448460 |
|---|---|
| Provider Enumeration Date | 08/24/2006 |
| Last Update Date | 11/19/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255448460 | NPI | - | NPPES |
| 036-096808 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036-096808 (Illinois) | Primary |
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