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General NPI Number Information
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NPI Number | 1093882458
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Entity Type | Individual
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Provider Name | USHA SRIRAM M.D
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Gender | Female
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2719 N HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60614-1413
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Country | US
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Telephone | 773-388-5685
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Fax | 773-388-5687
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Provider Business Mailing Address
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Address Line | 226 S GROVE AVE
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City | OAK PARK
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State | IL
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Zip | 60302-3110
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Country | US
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Telephone | 708-383-3060
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State | IL
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