Healthcare Provider Details

I. General information

NPI: 1750566550
Provider Name (Legal Business Name): SESHAN SUBRAMANIAN, M.D.,S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SOUTH MICHIGAN AVENE SUITE 408
CHICAGO IL
60616-2696
US

IV. Provider business mailing address

2600 SOUTH MICHIGAN AVENE SUITE 408
CHICAGO IL
60616
US

V. Phone/Fax

Practice location:
  • Phone: 312-326-3666
  • Fax: 312-326-3318
Mailing address:
  • Phone: 312-326-3666
  • Fax: 312-326-3318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. SESHAN SUBRAMANIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 312-326-3666