Healthcare Provider Details

I. General information

NPI: 1922261817
Provider Name (Legal Business Name): NILESHWA SHANMUGANATHAN SENTHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 S ADAMS STREET, SUITE 239
CARTHAGE IL
62321-1624
US

IV. Provider business mailing address

P.O. BOX 160
CARTHAGE IL
62321-0160
US

V. Phone/Fax

Practice location:
  • Phone: 217-357-0617
  • Fax: 217-357-0615
Mailing address:
  • Phone: 217-357-0617
  • Fax: 217-357-0615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2008-00853
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.137103
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00853
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: