Provider Demographics
NPI:1356327373
Name:NANDKUMAR, SESHADRICHARY (MD)
Entity Type:Individual
Prefix:DR
First Name:SESHADRICHARY
Middle Name:
Last Name:NANDKUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 MERCANTILE DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1256
Mailing Address - Country:US
Mailing Address - Phone:618-654-8985
Mailing Address - Fax:618-654-8650
Practice Address - Street 1:1270 MERCANTILE DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1256
Practice Address - Country:US
Practice Address - Phone:618-651-8097
Practice Address - Fax:618-651-8097
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054213207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054213-1Medicaid
ILCK0761OtherRR MEDICARE PIN
IL220033129Medicare PIN
ILE13618Medicare UPIN