MEDICARE: DR. BALASUBRAMANIAM S IYER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	036046165	IL
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	036046165	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497890750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BALASUBRAMANIAM S IYER MD

Provider Business Mailing Address
First Line	:	1945 W WILSON AVENUE
Second Line	:	SUITE #2115
City	:	CHICAGO
State	:	IL
Zip	:	60640-5255
Country	:	US
Telephone Number	:	773-878-5225
Fax Number	:	773-878-5661

Provider Business Practice Location Address
First Line	:	1945 W WILSON AVENUE
Second Line	:	SUITE #2115
City	:	CHICAGO
State	:	IL
Zip	:	60640-5255
Country	:	US
Telephone Number	:	773-878-5225
Fax Number	:	773-878-5661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	04/21/2010

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Directions to “ DR. BALASUBRAMANIAM S IYER MD” Practice Location

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