Provider Demographics
NPI:1750566550
Name:SESHAN SUBRAMANIAN, M.D.,S.C.
Entity type:Organization
Organization Name:SESHAN SUBRAMANIAN, M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SESHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBRAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-326-3666
Mailing Address - Street 1:2600 SOUTH MICHIGAN AVENE
Mailing Address - Street 2:SUITE 408
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616
Mailing Address - Country:US
Mailing Address - Phone:312-326-3666
Mailing Address - Fax:312-326-3318
Practice Address - Street 1:2600 SOUTH MICHIGAN AVENE
Practice Address - Street 2:SUITE 408
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2696
Practice Address - Country:US
Practice Address - Phone:312-326-3666
Practice Address - Fax:312-326-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL458550Medicare PIN
ILD12230Medicare UPIN