Provider Demographics
NPI:1124002290
Name:TRICHINAPALLY S NEELAKANTAM MD S C
Entity Type:Organization
Organization Name:TRICHINAPALLY S NEELAKANTAM MD S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRICHNIAPALLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEELAKANTAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-844-1818
Mailing Address - Street 1:1240 N HIGHLAND AVE
Mailing Address - Street 2:SUITE 22
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1450
Mailing Address - Country:US
Mailing Address - Phone:630-844-1818
Mailing Address - Fax:630-844-1429
Practice Address - Street 1:1240 N HIGHLAND AVE
Practice Address - Street 2:SUITE 22
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1450
Practice Address - Country:US
Practice Address - Phone:630-844-1818
Practice Address - Fax:630-844-1429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C45544Medicare UPIN
683530Medicare ID - Type Unspecified