MEDICARE: DR. SATHYA SUBBIAH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036-104472	IL
2	207RB0002X	Obesity Medicine (Internal Medicine) Physician	036-104472	IL
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	036-104472	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	279500	OTHER		MEDICARE GROUP
3	P00382810	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033128764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SATHYA SUBBIAH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 372
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-0372
Country	:	US
Telephone Number	:	217-868-2812
Fax Number	:	217-258-2216

Provider Business Practice Location Address
First Line	:	200 RICHMOND AVE E STE 3
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-4652
Country	:	US
Telephone Number	:	217-234-7000
Fax Number	:	217-234-2060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	01/22/2024

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Directions to “ DR. SATHYA SUBBIAH M.D.” Practice Location

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