Healthcare Provider Details

I. General information

NPI: 1487117602
Provider Name (Legal Business Name): SREEJA SOMPALLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2019
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 NORTH ST
WATERVILLE ME
04901-4974
US

IV. Provider business mailing address

751 N RUTLEDGE ST STE 2100
SPRINGFIELD IL
62702-4968
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-1328
  • Fax: 207-872-1765
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-4734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD29675
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: