Provider Demographics
NPI:1821083791
Name:PILLAI, ANANDAVALLY
Entity Type:Individual
Prefix:DR
First Name:ANANDAVALLY
Middle Name:
Last Name:PILLAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 ESSINGTON ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-2801
Mailing Address - Country:US
Mailing Address - Phone:815-744-4440
Mailing Address - Fax:815-744-9360
Practice Address - Street 1:1051 ESSINGTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2801
Practice Address - Country:US
Practice Address - Phone:815-744-4440
Practice Address - Fax:815-744-9360
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087425173000000X
IL036-087425207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087425Medicaid
IL09932356OtherBC/BS
IL09932356OtherBC/BS
ILK19570Medicare PIN