Provider Demographics
NPI:1891761094
Name:IYER, LAXMAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:LAXMAN
Middle Name:S
Last Name:IYER
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 1:215 E 1ST ST,
Mailing Address - Street 2:STE 212
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021
Mailing Address - Country:US
Mailing Address - Phone:815-285-5815
Mailing Address - Fax:815-285-5816
Practice Address - Street 1:215 E 1ST ST,
Practice Address - Street 2:STE 214
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021
Practice Address - Country:US
Practice Address - Phone:815-285-5815
Practice Address - Fax:815-285-5816
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-052760207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL82360OtherMEDICARE
IL036052760Medicaid
C45336Medicare UPIN