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General NPI Number Information
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NPI Number | 1023095601
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Entity Type | Individual
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Provider Name | SOMAN NAIR MD
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Gender | Male
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 12/14/2007
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Provider Practice Location Address
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Address Line | 1800 E LAKE SHORE DR
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City | DECATUR
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State | IL
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Zip | 62521-3883
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Country | US
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Telephone | 217-464-2984
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Fax | 217-464-1631
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Provider Business Mailing Address
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Address Line | 1800 E LAKE SHORE DR
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City | DECATUR
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State | IL
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Zip | 62521-3883
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Country | US
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Telephone | 217-464-2984
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4301037947
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35041649
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | IL
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