Provider Demographics
NPI:1063423093
Name:PALANI, COLATHUR K (MD)
Entity type:Individual
Prefix:
First Name:COLATHUR
Middle Name:K
Last Name:PALANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 NUTTALL RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1856
Mailing Address - Country:US
Mailing Address - Phone:708-442-8700
Mailing Address - Fax:708-442-8142
Practice Address - Street 1:3412 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-2365
Practice Address - Country:US
Practice Address - Phone:708-442-8700
Practice Address - Fax:708-442-8142
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
51142027OtherWAUSAU BENEFITS
IL216-09100OtherBCBS OF ILLINOIS
51142027OtherWAUSAU BENEFITS
D13560Medicare UPIN