Healthcare Provider Details

I. General information

NPI: 1720219843
Provider Name (Legal Business Name): SRINATH KAMINENI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 COLLEGE DR
MT CARMEL IL
62863
US

IV. Provider business mailing address

1527 COLLEGE DR
MOUNT CARMEL IL
62863-2615
US

V. Phone/Fax

Practice location:
  • Phone: 618-263-6400
  • Fax:
Mailing address:
  • Phone: 618-263-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberFL027
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036.178215
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: