Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 036049109 | IL |
N | 2084N0400X | Neurologist | 19525 | IA |
Y | 2084N0400X | Neurologist | 35123625 | OH |
N | 2084N0400X | Neurologist | ME88557 | FL |
N | 2084N0600X | Clinical Neurophysiologist | 036049109 | IL |
N | 2084N0600X | Clinical Neurophysiologist | 19525 | IA |
N | 2084N0600X | Clinical Neurophysiologist | 35123625 | OH |
N | 2084N0600X | Clinical Neurophysiologist | ME88557 | FL |
NPI | 1033197629 |
---|---|
Provider Name | Bakkiam Subbiah |
First Address | Cincinnati, OH 45206-1785 |
Second Address | Cincinnati, OH 45219-2364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 10/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036049109 | (05) | IL |
050739 | HEALTH ALLIANCE (01) | |
15929 | MIDLANDS CHOICE (01) | |
1996108 | (05) | IA |
20068 | IA HEALTH SOLUTIONS (01) | |
20957 | WELLMARK (01) | |
686137 | FIRST HEALTH (01) | |
8121085 | BCBS (01) | IL |
97295 | WELLMARK (01) | |
D13996 | (02) | |
IA0151 | JOHN DEERE FAMILY (01) | IA |
IL0136 | JOHN DEERE FAMILY (01) | IL |