Provider Demographics
NPI:1689672933
Name:NAIR, SUNITHA (MD)
Entity Type:Individual
Prefix:
First Name:SUNITHA
Middle Name:
Last Name:NAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MAIN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-5005
Mailing Address - Country:US
Mailing Address - Phone:224-522-9945
Mailing Address - Fax:309-672-4552
Practice Address - Street 1:900 MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-5005
Practice Address - Country:US
Practice Address - Phone:224-522-9945
Practice Address - Fax:309-672-4552
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI69845-20207R00000X
WI698452083P0011X
IL0361088972083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108897Medicaid
IL211799Medicare ID - Type Unspecified