Purushothaman, Rajamanickam
Purushothaman, Rajamanickam is an individual health care provider with primary practice located at 1965 S Fremont Ave Suite 300, Springfield MO 65804-2201. He recently has only one registered license in Allopathic & Osteopathic Physicians / Geriatric Medicine, which is considered as his primary health care specialty. Purushothaman, Rajamanickam can be contacted via phone (417) 820-3760.Contact Information
Primary practice address
1965 S Fremont Ave Suite 300
Springfield MO 65804-2201
Phone: (417) 820-3760
Fax: (417) 820-3770
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Geriatric Medicine | 207RG0300X | 105696 | Missouri |
Profile Details
| NPI number | 1558403519 |
|---|---|
| LBN Legal business name | Purushothaman, Rajamanickam |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 13th, 2007 |
| Last updated | Jul 22nd, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1558403519 | NPPES |
| Missouri | Other | 82272 | AR BLUE SHIELD # |
| Missouri | MEDICAID | 203973813 | AR BLUE SHIELD # |
| Missouri | MEDICAID | 148760001 | AR BLUE SHIELD # |
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