Basic Information
| Provider Information | |||||||||
| NPI: | 1356327373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NANDKUMAR | ||||||||
| FirstName: | SESHADRICHARY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1280 MERCANTILE DR | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622491256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186548985 | ||||||||
| FaxNumber: | 6186548650 | ||||||||
| Practice Location | |||||||||
| Address1: | 1270 MERCANTILE DR | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622491256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186518097 | ||||||||
| FaxNumber: | 6186518097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2005 | ||||||||
| LastUpdateDate: | 11/22/2010 | ||||||||
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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 | 207ZP0105X | 036054213 | IL | Y | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036054213-1 | 05 | IL | MEDICAID | CK0761 | 01 | IL | RR MEDICARE PIN | OTHER |