Susarla, Viswanatham
Susarla, Viswanatham is an individual health care provider with primary practice located at 860 Summit St Ste 123, Elgin IL 60120-5145. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Geriatric Medicine, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Susarla, Viswanatham can be contacted via phone (847) 741-0026.Contact Information
Primary practice address
860 Summit St Ste 123
Elgin IL 60120-5145
Phone: (847) 741-0026
Fax: (847) 741-0027
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Geriatric Medicine | 207RG0300X | 036047106 | Illinois |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 036047106 | Illinois |
Profile Details
| NPI number | 1922014315 |
|---|---|
| LBN Legal business name | Susarla, Viswanatham |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 31st, 2006 |
| Last updated | Jan 4th, 2022 - about 3 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 | 1922014315 | NPPES |
| Illinois | Other | 0004500476 | BLUE CROSS BLUE SHIELD |
| Illinois | MEDICAID | 036047106 | BLUE CROSS BLUE SHIELD |
| Illinois | Other | 112910380 | BLUE CROSS BLUE SHIELD |
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