1033197629 NPI number — BAKKIAM SUBBIAH MD

Table of content: BAKKIAM SUBBIAH MD (NPI 1033197629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033197629 NPI number — BAKKIAM SUBBIAH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUBBIAH
Provider First Name:
BAKKIAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033197629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2830 VICTORY PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45206-1785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-585-6200
Provider Business Mailing Address Fax Number:
513-245-3672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
234 GOODMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45219-2364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-475-8730
Provider Business Practice Location Address Fax Number:
513-475-8033
Provider Enumeration Date:
01/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0600X , with the licence number:  036049109 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 35123625 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0600X , with the licence number: 19525 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: ME88557 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 19525 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 036049109 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X , with the licence number: 35123625 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X , with the licence number: ME88557 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: IL0136 . This is a "JOHN DEERE FAMILY" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 20957 . This is a "WELLMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: IA0151 . This is a "JOHN DEERE FAMILY" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 8121085 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036049109 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050739 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15929 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20068 . This is a "IA HEALTH SOLUTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 686137 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1996108 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 97295 . This is a "WELLMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 114691000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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