Provider Demographics
NPI:1992811715
Name:PILLAY, VEERASAMY KISTA,GOVINDA
Entity type:Individual
Prefix:PROF
First Name:VEERASAMY
Middle Name:KISTA,GOVINDA
Last Name:PILLAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 THATCHER AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-2029
Mailing Address - Country:US
Mailing Address - Phone:708-771-6169
Mailing Address - Fax:312-569-8040
Practice Address - Street 1:900 SOUTH DAMEN AVE
Practice Address - Street 2:JESSE BROWN VAMC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-569-8387
Practice Address - Fax:312-569-8040
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13641Medicare UPIN
IL927060/P03090Medicare ID - Type Unspecified