MEDICARE: DR. USHA SRIRAM M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician		IL

General Provider Information

NPI Number	:	1093882458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. USHA SRIRAM M.D

Provider Business Mailing Address
First Line	:	226 S GROVE AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-3110
Country	:	US
Telephone Number	:	708-383-3060
Fax Number	:

Provider Business Practice Location Address
First Line	:	2719 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1413
Country	:	US
Telephone Number	:	773-388-5685
Fax Number	:	773-388-5687

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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