=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629124243
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANAND PONNAPPAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 02/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1005 HEALTH CENTER DR STE 201
-----------------------------------------------------
City | MATTOON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61938-4653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-258-2409
-----------------------------------------------------
Fax | 217-258-2323
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 147 S DELAPLAINE RD
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60546-2371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-853-9367
-----------------------------------------------------
Fax | 708-659-4997
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 036123972
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------