Gopinathan Gangadharan Nambiar, | |
2901 Old Jacksonville Rd, Springfield, IL 62704-7437 | |
(217) 698-9722 | |
(217) 391-0392 |
Full Name | Gopinathan Gangadharan Nambiar |
---|---|
Gender | Male |
Speciality | Pediatrics |
Location | 2901 Old Jacksonville Rd, Springfield, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1013395250 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 036142874 (Illinois) | Primary |
Entity Name | Blue Ridge Medical Management Corporation |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1144380833 PECOS PAC ID: 9739099441 Enrollment ID: O20031204000996 |
Mailing Address | Practice Location Address |
---|---|
Gopinathan Gangadharan Nambiar, 2901 Old Jacksonville Rd, Springfield, IL 62704-7437 Ph: (217) 698-9722 | Gopinathan Gangadharan Nambiar, 2901 Old Jacksonville Rd, Springfield, IL 62704-7437 Ph: (217) 698-9722 |
Stephanie E. Wojtowicz, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2532 Farragut Dr, Springfield, IL 62704 Phone: 217-787-9424 | |
Claudine Gillison, Pediatrics Medicare: Medicare Enrolled Practice Location: 2532 Farragut Dr, Springfield, IL 62704 Phone: 217-528-7541 | |
Dr. Susan M. Soler, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2532 Farragut Dr, Springfield, IL 62704 Phone: 217-787-9424 | |
Dr. Kimberly Nichole Powell, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 415 N 9th St, Suite 4w16, Springfield, IL 62702 Phone: 217-545-8000 Fax: 217-757-6654 | |
Misty M. Phillips, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 2532 Farragut Dr, Springfield, IL 62704 Phone: 217-528-7541 | |
Tracy P Milbrandt, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 301 N 8th St, Springfield, IL 62701 Phone: 217-545-4238 Fax: 217-545-2303 |