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Individual
DR. VISWANATHAM SUSARLA
Active
Individual
DR. VISWANATHAM SUSARLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036047106
IL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
036047106
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004500476
BLUE CROSS BLUE SHIELD
IL
05
—
036047106
—
IL
01
—
112910380
RAILROAD MEDICARE
IL
Enumeration date
07/31/2006
Last updated
01/04/2022
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