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General NPI Number Information
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NPI Number | 1023124302
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Entity Type | Organization
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Legal Business Name | DANVILLE PAIN & REHABILITATION MEDICINE CENTER, LLC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 733 N LOGAN AVE
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City | DANVILLE
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State | IL
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Zip | 61832-4378
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Country | US
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Telephone | 217-267-2175
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Fax | 217-267-2179
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Provider Business Mailing Address
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Address Line | 733 N LOGAN AVE
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City | DANVILLE
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State | IL
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Zip | 61832-4378
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Country | US
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Telephone | 217-267-2175
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Fax | 217-267-2179
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Authorized Official
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Title or Position | PHYSICIAN
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Name | SRINIVAS SUNKAVALLY
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Credential | M.D.
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Telephone | 217-267-2175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State | IL
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