Individual
VEERASIKKU BOMMIASAMY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
695 N KELLOGG ST, GALESBURG, IL 61401-2807
(309) 343-8131
Mailing address
PO BOX 960416, OKLAHOMA CITY, OK 73196-0001
(877) 485-4474
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036051814
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360518141
—
IL
05
—
0360518146
—
IL
01
—
36051814
BLUE SHIELD
IL
01
—
P00347048
RAILROAD MEDICARE
IL
01
—
P00936471
RRMCARE THRU CESIISC (GES)
IL
Enumeration date
07/09/2006
Last updated
08/17/2011
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