Jagannathan, Subbia G
Jagannathan, Subbia G is an individual health care provider with primary practice located at 695 N Kellogg St , Galesburg IL 61401-2807. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Jagannathan, Subbia G can be contacted via phone (309) 345-4219.Contact Information
Primary practice address
695 N Kellogg St
Galesburg IL 61401-2807
Phone: (309) 345-4219
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 036046940 | Illinois |
Profile Details
| NPI number | 1184679953 |
|---|---|
| LBN Legal business name | Jagannathan, Subbia G |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 23rd, 2006 |
| Last updated | May 12th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184679953 | NPPES |
| Illinois | MEDICAID | 0360469401 | |
| Illinois | Other | 300026080 |
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