Provider Demographics
NPI:1598853368
Name:SUBRAMANI, VISHNU (MD)
Entity Type:Individual
Prefix:DR
First Name:VISHNU
Middle Name:
Last Name:SUBRAMANI
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 1:2909 INDEPENDENCE
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5044
Mailing Address - Country:US
Mailing Address - Phone:573-332-7297
Mailing Address - Fax:573-332-0077
Practice Address - Street 1:2909 INDEPENDENCE
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5044
Practice Address - Country:US
Practice Address - Phone:573-332-7297
Practice Address - Fax:573-332-0077
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005005184207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207306200Medicaid
934753435Medicare ID - Type Unspecified
MO207306200Medicaid