Individual
SHANTI PRIYA SUBBARAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
301 E SOUTHLINE RD, TUSCOLA, IL 61953-2014
(217) 253-5231
(217) 253-4082
Mailing address
611 W PARK ST, URBANA, IL 61801-2501
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036139178
IL
207Q00000X
Family Medicine Physician
35.126085
OH
208M00000X
Hospitalist Physician
Primary
036.139178
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0128393
—
OH
Enumeration date
04/05/2012
Last updated
04/19/2026
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