MEDICARE: RADHIKA SREEDHAR M.D., M.S.

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	207R00000X	Internal Medicine Physician	036-099380	IL

General Provider Information

NPI Number	:	1558341677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RADHIKA SREEDHAR M.D., M.S.

Provider Business Mailing Address
First Line	:	1801 W TAYLOR STREET
Second Line	:	3AA
City	:	CHICAGO
State	:	IL
Zip	:	60612-4795
Country	:	US
Telephone Number	:	312-413-3627
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 W TAYLOR ST
Second Line	:	3AA
City	:	CHICAGO
State	:	IL
Zip	:	60612-4795
Country	:	US
Telephone Number	:	312-413-3627
Fax Number	:

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	02/24/2015

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