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NPI Code Detail

MEDICARE: SUBRAMANYAM CHITTIVELU M.D.

MEDICARE: SUBRAMANYAM CHITTIVELU 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
1207RP1001XPulmonary Disease Physician036105660IL
2207RS0012XSleep Medicine (Internal Medicine) Physician036105660IL
3207RC0200XCritical Care Medicine (Internal Medicine) Physician036105660IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1IL2690008OTHERMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932195880
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUBRAMANYAM CHITTIVELU M.D.
Provider Business Mailing Address
First Line : 1001 MAIN ST
Second Line : SUITE 200
City : PEORIA
State : IL
Zip : 61606-1907
Country : US
Telephone Number : 309-672-5682
Fax Number : 309-672-3147
Provider Business Practice Location Address
First Line : 1001 MAIN ST
Second Line : SUITE 200
City : PEORIA
State : IL
Zip : 61606-1907
Country : US
Telephone Number : 309-672-5682
Fax Number : 309-672-3147
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2005
Last Update Date : 01/21/2025

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Directions to “ SUBRAMANYAM CHITTIVELU M.D.” Practice Location

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