Basic Information
| Provider Information | |||||||||
| NPI: | 1346235264 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VEERABAHU | ||||||||
| FirstName: | ANAND | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 E BROADWAY | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652015844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738158000 | ||||||||
| FaxNumber: | 5738158556 | ||||||||
| Practice Location | |||||||||
| Address1: | 4201 W MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157594323 | ||||||||
| FaxNumber: | 8157594948 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2005 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2018016848 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 19579 | NV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 64714 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 036-105435 | IL | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 036105435 | IL | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 64714 | MN | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 2018016848 | MO | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 19579 | NV | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 036105435 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036-105435 | 05 | IL | MEDICAID | BV7402011 | 01 | IL | DEA | OTHER |