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Individual

MRS. BINDU PAVITHRAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
612 ROXBURY RD, ROCKFORD, IL 61107-5089
(815) 227-8300
(815) 227-8301
Mailing address
612 ROXBURY RD, ROCKFORD, IL 61107-5089
(815) 227-8300
(815) 227-8301

Taxonomy

Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
036110997
IL
207RN0300X
Nephrology Physician
Primary
MD491041C
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036110997
IL
01
922820
GROUP PTAN
IL
01
P00847277
RAILROAD MEDICARE PTAN
IL
Enumeration date
05/11/2006
Last updated
10/02/2025
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