Individual
SRINIVASARAO C YAGANTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-6220
(618) 257-6679
Mailing address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-6220
(618) 257-6679
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-094107
IL
208M00000X
Hospitalist Physician
Primary
036-094107
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036094107
—
IL
01
—
110132770
RAILROAD MEDICARE
—
Enumeration date
07/24/2006
Last updated
03/31/2021
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