Provider Demographics
NPI:1811284375
Name:TONLAAR, NATHAN YENNUMI (MD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:YENNUMI
Last Name:TONLAAR
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2055 S FREMONT AVE
Mailing Address - Street 2:MERCY CLINIC RADIATION ONCOLOGY, CHAUB O'REILLY CENTER
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2206
Mailing Address - Country:US
Mailing Address - Phone:417-820-2468
Mailing Address - Fax:417-820-7794
Practice Address - Street 1:2055 S FREMONT AVE
Practice Address - Street 2:MERCY CLINIC RADIATION ONCOLOGY, CHAUB O'REILLY CENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2206
Practice Address - Country:US
Practice Address - Phone:417-820-2468
Practice Address - Fax:417-820-7794
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2016-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010994232085R0001X
MO20160147802085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology