Individual
DR. SUJITHA SREE KETINENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
315 W CARPENTER ST # B, SPRINGFIELD, IL 62702-4901
(217) 545-8000
(217) 545-1141
Mailing address
PO BOX 19678, SPRINGFIELD, IL 62794-9678
(217) 545-8000
(217) 545-1141
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
036.156940
IL
390200000X
Student in an Organized Health Care Education/Training Program
125071938
IL
Other
Enumeration date
07/09/2018
Last updated
06/29/2021
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