MEDICARE: MANI N SUBRAMANIAN 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	174400000X	Specialist	036058679	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	110248785	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0004405317	OTHER	IL	AETNA
2	01627643	OTHER	IL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730163676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANI N SUBRAMANIAN M.D.

Provider Business Mailing Address
First Line	:	1872 BIG BEND DR
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-3517
Country	:	US
Telephone Number	:	847-640-0513
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 N RIVER RD
Second Line	:	SUITE #240
City	:	DES PLAINES
State	:	IL
Zip	:	60016-1272
Country	:	US
Telephone Number	:	847-391-9877
Fax Number	:	847-391-9177

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/02/2008

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Directions to “ MANI N SUBRAMANIAN M.D.” Practice Location

Language	Start Address	Practice Location

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