Provider Demographics
NPI:1760974950
Name:SUBBU, KARTHIK (MD)
Entity Type:Individual
Prefix:
First Name:KARTHIK
Middle Name:
Last Name:SUBBU
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 1:302 RANDALL RD STE 304
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4205
Mailing Address - Country:US
Mailing Address - Phone:630-208-6775
Mailing Address - Fax:630-208-7937
Practice Address - Street 1:302 RANDALL RD STE 304
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4205
Practice Address - Country:US
Practice Address - Phone:630-208-6775
Practice Address - Fax:630-208-7937
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11019958A390200000X
IL036164909207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program