Individual
DR. ELIATHAMBY KUGANESWARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 W MAIN ST, SUITE 500A, PEORIA, IL 61606-1276
(309) 672-4980
(309) 671-2944
Mailing address
PO BOX 365, MORTON, IL 61550-0365
(309) 672-4980
(309) 671-2944
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036105345
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036105345
—
IL
01
—
071696
HEALTH ALLIANCE
IL
01
—
07215152
BLUE CROSS
IL
01
—
100015542
RAILROAD MEDICARE
IL
01
—
371221637
FEDERAL TAX IDENTIFICATIO
IL
01
—
658303
HEALTHLINK
IL
01
—
776530
MEDICARE GROUP NUMBER
IL
01
—
7991429
AETNA HEALTH PLANS
IL
01
—
IL0117
JOHN DEERE
IL
Enumeration date
06/11/2006
Last updated
05/28/2009
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