Healthcare Provider Details

I. General information

NPI: 1063090173
Provider Name (Legal Business Name): SRUTHI SATHYAKUMAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SRUTHI DINAKARAN

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 S DELANO CT E STE A201
CHICAGO IL
60605-3482
US

IV. Provider business mailing address

2900 N LAKE SHORE DR
CHICAGO IL
60657-5640
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-3627
  • Fax: 312-694-9287
Mailing address:
  • Phone: 773-665-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number036169406
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: