Provider Demographics
NPI:1417190216
Name:MUTHULINGAM, VARATHASEELAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VARATHASEELAN
Middle Name:
Last Name:MUTHULINGAM
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:P O BOX 1105
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1105
Mailing Address - Country:US
Mailing Address - Phone:618-549-5361
Mailing Address - Fax:618-549-5128
Practice Address - Street 1:201 S 14TH ST
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3631
Practice Address - Country:US
Practice Address - Phone:618-942-2171
Practice Address - Fax:618-351-4919
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122038208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00757187OtherRAILROAD MEDICARE
IL976183OtherHEALTHLINK
IL036122038OtherILLINOIS LICENSE
IL036122038Medicaid
IL165651OtherHEALTH ALLIANCE
IL214881059Medicare PIN