Individual
MANI N SUBRAMANIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
150 N RIVER RD, SUITE #240, DES PLAINES, IL 60016-1272
(847) 391-9877
(847) 391-9177
Mailing address
1872 BIG BEND DR, DES PLAINES, IL 60016-3517
(847) 640-0513
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036058679
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004405317
AETNA
IL
01
—
01627643
BLUE CROSS BLUE SHIELD
IL
05
—
036058679 3
—
IL
01
—
110248785
RAILROAD MEDICARE
IL
Enumeration date
12/05/2005
Last updated
07/02/2008
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