Individual
PRABHAMANI IYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
101 E MILLER RD, STERLING, IL 61081-1252
(815) 625-4790
Mailing address
101 E MILLER RD, STERLING, IL 61081-1252
(815) 625-4790
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036053066
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011552
HEALTH ALLIANCE MEDICAL
IL
05
—
036053066
—
IL
01
—
9815737
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/10/2006
Last updated
08/13/2012
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