Individual
SRIPATHY RAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2875 W 19TH ST, CHICAGO, IL 60623-3501
(312) 332-6626
Mailing address
11428 BURR OAK LN, BURR RIDGE, IL 60527-5158
(312) 829-0005
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0021603862
BCBS
IL
Enumeration date
10/12/2006
Last updated
07/08/2007
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