1508907122 NPI number — NARAYANAPPA SATHISH BABU MD, MS, FRCS, M.SC

Table of content: NARAYANAPPA SATHISH BABU MD, MS, FRCS, M.SC (NPI 1508907122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508907122 NPI number — NARAYANAPPA SATHISH BABU MD, MS, FRCS, M.SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BABU
Provider First Name:
NARAYANAPPA
Provider Middle Name:
SATHISH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, MS, FRCS, M.SC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BABU
Provider Other First Name:
SATHISH
Provider Other Middle Name:
NARAYANAPPA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD,MS,FRCS,M.SC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1508907122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 LILAC ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLINGBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60490-2020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-553-9058
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8348 LEMONT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARIEN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60561-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-354-7565
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2007

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: 207Q00000X , with the licence number:  036.122098 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0401X , with the licence number: 036.122098 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0505X , with the licence number: 036.122098 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X , with the licence number: 036.122098 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 036.122098 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RA0401X , with the licence number: 036.122098 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083P0901X , with the licence number: 036.122098 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 036.122098 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 036.122098 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: 036.122098 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 60025-30 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: IL 2437002 . This is a "INDIVIDUAL PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 60202-01 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 213215007 . This is a "INDIVIDUAL PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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