Provider Demographics
NPI:1609059708
Name:B.S. IYER M.D., S.C.
Entity Type:Organization
Organization Name:B.S. IYER M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BALASUBRAMANIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:IYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-878-5225
Mailing Address - Street 1:1945 W WILSON AVE
Mailing Address - Street 2:SUITE #2115
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5255
Mailing Address - Country:US
Mailing Address - Phone:773-878-5225
Mailing Address - Fax:773-878-5661
Practice Address - Street 1:1945 W WILSON AVE
Practice Address - Street 2:SUITE #2115
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5255
Practice Address - Country:US
Practice Address - Phone:773-878-5225
Practice Address - Fax:773-878-5661
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BS IYER MD SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-11
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046165174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK18231OtherMEDICARE
IL36046165Medicaid
211814OtherUPIN