Individual
SUBRAMANYAM CHITTIVELU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 MAIN ST, SUITE 200, PEORIA, IL 61606-1907
(309) 672-5682
(309) 672-3147
Mailing address
1001 MAIN ST, SUITE 200, PEORIA, IL 61606-1907
(309) 672-5682
(309) 672-3147
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
036105660
IL
207RP1001X
Pulmonary Disease Physician
036105660
IL
207RS0012X
Sleep Medicine (Internal Medicine) Physician
036105660
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036105660
—
IL
01
—
IL2690008
MEDICARE PTAN
—
Enumeration date
09/26/2005
Last updated
01/21/2025
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