Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 036-104472 | IL |
NPI | 1033128764 |
---|---|
Provider Name | Dr. Sathya Subbiah |
First Address | Mattoon, IL 61938-4653 |
Second Address | Mattoon, IL 61938-4652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036104472 1 | (05) | IL |
279500 | MEDICARE GROUP (01) | |
H51546 | (02) | IL |
P00382810 | RAILROAD MEDICARE (01) |