MEDICARE: DR. VENKATA SASIDHAR MAJJIGA MD

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	2080N0001X	Neonatal-Perinatal Medicine Physician	036.127301	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255623997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VENKATA SASIDHAR MAJJIGA MD

Provider Business Mailing Address
First Line	:	PO BOX 19676
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62794-9676
Country	:	US
Telephone Number	:	800-331-2229
Fax Number	:	217-757-6488

Provider Business Practice Location Address
First Line	:	301 N 8TH STREET, SIU SCHOOL OF MEDICINE, PEDIATRICS
Second Line	:	ROOM 3A169
City	:	SPRINGFIELD
State	:	IL
Zip	:	62794
Country	:	US
Telephone Number	:	217-545-7732
Fax Number	:	217-757-6488

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

Provider Enumeration Date	:	05/13/2011
Last Update Date	:	05/25/2011

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