Healthcare Provider Details

I. General information

NPI: 1730983636
Provider Name (Legal Business Name): RACHNA SRIDHAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

5841 S MARYLAND AVE
CHICAGO IL
60637-1443
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1860
  • Fax: 773-702-2883
Mailing address:
  • Phone: 773-702-1860
  • Fax: 773-702-2883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number125.087642
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: