Healthcare Provider Details

I. General information

NPI: 1669502688
Provider Name (Legal Business Name): SRI MEDICAL CARE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 MEDICAL CENTER DR SUITE 210
BOLINGBROOK IL
60440-4925
US

IV. Provider business mailing address

PO BOX 5339
VILLA PARK IL
60181-5301
US

V. Phone/Fax

Practice location:
  • Phone: 574-273-6546
  • Fax: 574-273-5295
Mailing address:
  • Phone: 574-273-6546
  • Fax: 574-273-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. RAMADEVI DAVARAPALLI
Title or Position: OWNER
Credential: MD
Phone: 630-226-1800