Provider Demographics
NPI:1639487911
Name:VISWANATHAN, AVINASH KASHYAP (MD)
Entity Type:Individual
Prefix:MR
First Name:AVINASH
Middle Name:KASHYAP
Last Name:VISWANATHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3132 OLD JACKSONVILLE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-7400
Mailing Address - Country:US
Mailing Address - Phone:217-862-0741
Mailing Address - Fax:217-862-0858
Practice Address - Street 1:3132 OLD JACKSONVILLE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7400
Practice Address - Country:US
Practice Address - Phone:217-862-0741
Practice Address - Fax:217-862-0858
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.133495207R00000X
IL336.094733207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine