Individual
SUBBIA G JAGANNATHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
695 N KELLOGG ST, GALESBURG, IL 61401-2807
(309) 345-4219
Mailing address
PO BOX 989, GALESBURG, IL 61402-0989
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036046940
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360469401
—
IL
01
—
300026080
RAILROAD MEDICARE
IL
Enumeration date
05/23/2006
Last updated
05/12/2011
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