Healthcare Provider Details

I. General information

NPI: 1093918203
Provider Name (Legal Business Name): VENKAT SESHADRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19801 GOVERNORS HWY STE 160
FLOSSMOOR IL
60422-4363
US

IV. Provider business mailing address

19801 GOVERNORS HWY STE 160
FLOSSMOOR IL
60422-4363
US

V. Phone/Fax

Practice location:
  • Phone: 708-957-0505
  • Fax: 708-957-0506
Mailing address:
  • Phone: 708-957-0505
  • Fax: 708-957-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036133341
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: