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NPI Code Detail

MEDICARE: SUBRAMANIAM KOLANDAIVELU M.D.

MEDICARE: SUBRAMANIAM KOLANDAIVELU M.D.
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
1207R00000XInternal Medicine PhysicianIL

General Provider Information

NPI Number : 1770509671
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUBRAMANIAM KOLANDAIVELU M.D.
Provider Business Mailing Address
First Line : 422 W WHITE ST
Second Line :
City : CLINTON
State : IL
Zip : 61727-2272
Country : US
Telephone Number : 217-935-3706
Fax Number :
Provider Business Practice Location Address
First Line : 422 W WHITE ST
Second Line :
City : CLINTON
State : IL
Zip : 61727-2272
Country : US
Telephone Number : 217-935-3706
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 07/09/2007

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