Healthcare Provider Details

I. General information

NPI: 1366706079
Provider Name (Legal Business Name): PIYUSH KUMAR SINGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 ILLINI DR STE 303
SILVIS IL
61282-2904
US

IV. Provider business mailing address

855 ILLINI DR STE 303
SILVIS IL
61282-2904
US

V. Phone/Fax

Practice location:
  • Phone: 309-281-2350
  • Fax: 309-281-2359
Mailing address:
  • Phone: 309-281-2350
  • Fax: 309-281-2359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number59020
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036149286
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: