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NPI Code Detail

MEDICARE: DR. ATKAVI SAWADISAVI MD

MEDICARE: DR. ATKAVI SAWADISAVI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery PhysicianIL

General Provider Information

NPI Number : 1144211764
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ATKAVI SAWADISAVI MD
Provider Business Mailing Address
First Line : PO BOX 220
Second Line :
City : PINCKNEYVILLE
State : IL
Zip : 62274-0220
Country : US
Telephone Number : 918-357-5920
Fax Number : 618-357-3096
Provider Business Practice Location Address
First Line : 101 N WALNUT ST
Second Line :
City : PINCKNEYVILLE
State : IL
Zip : 62274-1034
Country : US
Telephone Number : 618-357-5920
Fax Number : 618-357-3096
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 07/08/2007

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