MEDICARE: DR. SRINIDHI MUSUNURI 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	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	036-106778	IL

General Provider Information

NPI Number	:	1780678920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SRINIDHI MUSUNURI M.D.

Provider Business Mailing Address
First Line	:	801 S MILWAUKEE AVE
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-3204
Country	:	US
Telephone Number	:	847-990-5149
Fax Number	:	847-918-0713

Provider Business Practice Location Address
First Line	:	801 S MILWAUKEE AVE
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-3204
Country	:	US
Telephone Number	:	847-990-5149
Fax Number	:	847-918-0713

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	11/13/2008

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