Provider Demographics
NPI:1881875136
Name:NEELAKANTAM, T S (MD)
Entity type:Individual
Prefix:
First Name:T
Middle Name:S
Last Name:NEELAKANTAM
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 1:1240 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1450
Mailing Address - Country:US
Mailing Address - Phone:630-844-1818
Mailing Address - Fax:630-844-1429
Practice Address - Street 1:1240 N HIGHLAND AVENUE
Practice Address - Street 2:SUITE 22
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506
Practice Address - Country:US
Practice Address - Phone:630-844-1818
Practice Address - Fax:630-844-1429
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC45544Medicare UPIN
IL683530Medicare PIN