Individual
BHUVANESWARI SUBRAMANIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 624-8818
Mailing address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 624-8818
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
809840
MEDICARE GROUP #
IL
01
—
CA4079
RR GROUP
IL
01
—
P00437041
RR INDIVIDUAL
IL
Enumeration date
10/20/2007
Last updated
01/23/2008
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