Provider Demographics
NPI:1881430510
Name:IYENGAR GERIATRIC HOSPITALIST SC
Entity type:Organization
Organization Name:IYENGAR GERIATRIC HOSPITALIST SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANILO
Authorized Official - Middle Name:R
Authorized Official - Last Name:COITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-848-1032
Mailing Address - Street 1:1740 OAK AVE STE C1C2
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-5989
Mailing Address - Country:US
Mailing Address - Phone:773-697-3729
Mailing Address - Fax:
Practice Address - Street 1:10343 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3638
Practice Address - Country:US
Practice Address - Phone:773-697-3729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care