Healthcare Provider Details

I. General information

NPI: 1720343072
Provider Name (Legal Business Name): SRIKANTH MARKAPURAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CARPENTER ST
SPRINGFIELD IL
62769-1000
US

IV. Provider business mailing address

1900 N HIGLEY ROAD ATTN: HOSPITALISTS
GILBERT AZ
85234
US

V. Phone/Fax

Practice location:
  • Phone: 217-544-6464
  • Fax: 217-757-6805
Mailing address:
  • Phone: 480-543-2034
  • Fax: 480-543-2647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50110
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125061461
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number50110
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036054967
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: