Individual
SRIDHAR VALLABHANENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2901 W KINNICKINNIC RIVER PKWY STE 310, MILWAUKEE, WI 53215-5643
(414) 649-3300
(414) 649-7012
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
01074949A
IN
208100000X
Physical Medicine & Rehabilitation Physician
036.137251
IL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
72134
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036137251
—
IL
05
—
100095270
—
WI
01
—
12591405
CAQH
IL
05
—
201297670
—
IN
Enumeration date
05/14/2010
Last updated
12/11/2025
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