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General NPI Number Information
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NPI Number | 1609059708
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Entity Type | Organization
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Legal Business Name | B.S. IYER M.D., S.C.
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 02/24/2010
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Provider Practice Location Address
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Address Line | 1945 W WILSON AVE SUITE #2115
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City | CHICAGO
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State | IL
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Zip | 60640-5255
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Country | US
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Telephone | 773-878-5225
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Fax | 773-878-5661
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Provider Business Mailing Address
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Address Line | 1945 W WILSON AVE SUITE #2115
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City | CHICAGO
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State | IL
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Zip | 60640-5255
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Country | US
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Telephone | 773-878-5225
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Fax | 773-878-5661
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Authorized Official
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Title or Position | OWNER
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Name | BALASUBRAMANIAM S. IYER
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Credential | M.D.
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Telephone | 773-878-5225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036046165
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License Number State | IL
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