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General NPI Number Information
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NPI Number | 1598919755
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Entity Type | Organization
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Legal Business Name | DRS SRIPADA MD SC
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 361 PARK AVE STE 202
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City | GLENCOE
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State | IL
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Zip | 60022-1587
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Country | US
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Telephone | 847-835-9085
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Fax |
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Provider Business Mailing Address
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Address Line | 361 PARK AVE STE 202
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City | GLENCOE
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State | IL
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Zip | 60022-1587
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Country | US
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Telephone | 847-835-9085
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. TERESA SRIPADA
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Credential | MD
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Telephone | 847-835-9085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 36054375
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License Number State | IL
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