Basic Information
| Provider Information | |||||||||
| NPI: | 1285642439 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAUL | ||||||||
| FirstName: | SATNAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 532912 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303532912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173372000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1400 W PARK ST | ||||||||
| Address2: | |||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618012334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173372000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 10/18/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 36110164 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 36110164 | 05 | IL | MEDICAID | P00146813 | 01 | IL | RR MEDICARE | OTHER | 1032044 | 01 | IL | BCBS | OTHER | DA52383 | 01 | IL | RR MEDICARE GROUP | OTHER |