Provider Demographics
NPI:1821266792
Name:P.SARAVANAN, MD.,SC.
Entity Type:Organization
Organization Name:P.SARAVANAN, MD.,SC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATHANJALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SARAVANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-352-6666
Mailing Address - Street 1:2407 S NEIL ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7721
Mailing Address - Country:US
Mailing Address - Phone:217-352-6666
Mailing Address - Fax:217-352-6683
Practice Address - Street 1:2407 S NEIL ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7721
Practice Address - Country:US
Practice Address - Phone:217-352-6666
Practice Address - Fax:217-352-6683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG35321Medicare UPIN