Individual
DR. PETHAM MUTHUSWAMY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7531 SOUTH STONY ISLAND, SUITE 169, CHICAGO, IL 60649
(773) 947-7715
(773) 643-0175
Mailing address
7531 SOUTH STONY ISLAND, SUITE 169, CHICAGO, IL 60649
(773) 947-7715
(773) 643-0175
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036047024
IL
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
03604724
IL
207RP1001X
Pulmonary Disease Physician
Primary
03604724
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002201085
BLUE CROSS BLUE SHIELD
IL
05
—
036047024
—
IL
01
—
110017592
TRM
IL
01
—
202773
UNITED HEALTH CARE
IL
01
—
3048491
BCBS OF TN
TN
01
—
362993972
TAX ID #
IL
01
—
46K13
EMPIRE BCBS
IL
01
—
4880209
SHARE
IL
Enumeration date
10/04/2006
Last updated
03/07/2023
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