Provider Demographics
NPI:1023095601
Name:NAIR, SOMAN (MD)
Entity type:Individual
Prefix:
First Name:SOMAN
Middle Name:
Last Name:NAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NAGAVALLIL
Other - Middle Name:GOPALA PILLAI
Other - Last Name:SOMAN NAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1800 E LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3883
Mailing Address - Country:US
Mailing Address - Phone:217-464-2984
Mailing Address - Fax:
Practice Address - Street 1:1800 E LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3883
Practice Address - Country:US
Practice Address - Phone:217-464-2984
Practice Address - Fax:217-464-1631
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010379472085R0202X
OH350416492085R0202X
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL38334Medicare UPIN