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NPI Code Detail

MEDICARE: DR. NANTHINI SUTHAN M.D

MEDICARE: DR. NANTHINI SUTHAN 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
1207R00000XInternal Medicine Physician059772GA
2207R00000XInternal Medicine Physician036126643IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1448758879AOTHERGAPEACHCARE FOR KIDS

General Provider Information

NPI Number : 1053504506
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NANTHINI SUTHAN M.D
Provider Business Mailing Address
First Line : 12860 TROXLER AVE
Second Line :
City : HIGHLAND
State : IL
Zip : 62249-2898
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12860 TROXLER AVE
Second Line :
City : HIGHLAND
State : IL
Zip : 62249-2898
Country : US
Telephone Number : 618-651-2810
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2007
Last Update Date : 02/07/2025

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