Individual
REVATHI SWAMINATHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
221 NE GLEN OAK AVE, PEORIA, IL 61636-0001
(309) 672-5700
(309) 671-2774
Mailing address
450 MAYO DR, GALESBURG, IL 61401-1211
(309) 344-2831
(309) 344-2014
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
036062991
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036062991
—
IL
01
—
254642
HEALTHLINK
—
01
—
CM5868
RAILROAD MEDICARE
—
01
—
RAILROAD MED PIN
P00310337
—
Enumeration date
06/16/2006
Last updated
03/08/2016
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