MEDICARE: B. S. KESAVAN 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	208000000X	Pediatrics Physician	036052418	IL

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	:	1396744868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	B. S. KESAVAN M.D.

Provider Business Mailing Address
First Line	:	834 N SEMINARY ST
Second Line	:	SUITE 302
City	:	GALESBURG
State	:	IL
Zip	:	61401-2852
Country	:	US
Telephone Number	:	309-342-2171
Fax Number	:	309-342-7205

Provider Business Practice Location Address
First Line	:	834 N SEMINARY ST
Second Line	:	SUITE 302
City	:	GALESBURG
State	:	IL
Zip	:	61401-2852
Country	:	US
Telephone Number	:	309-342-2171
Fax Number	:	309-342-7205

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	02/17/2012

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