Provider Demographics
NPI:1033128764
Name:SUBBIAH, SATHYA (MD)
Entity Type:Individual
Prefix:DR
First Name:SATHYA
Middle Name:
Last Name:SUBBIAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-0372
Mailing Address - Country:US
Mailing Address - Phone:217-868-2812
Mailing Address - Fax:217-258-2216
Practice Address - Street 1:200 RICHMOND AVE E STE 3
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4652
Practice Address - Country:US
Practice Address - Phone:217-234-7000
Practice Address - Fax:217-234-2060
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-104472207R00000X, 207RB0002X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104472 1Medicaid
279500OtherMEDICARE GROUP
P00382810OtherRAILROAD MEDICARE
279500OtherMEDICARE GROUP
IL0407950001Medicare NSC
K37436Medicare PIN