Individual
SHREEPADA TRIPATHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
415 N 9TH ST, SUITE 4W64, SPRINGFIELD, IL 62702-5303
(217) 545-8000
(217) 757-6519
Mailing address
415 N 9TH ST, PO BOX 19676, SPRINGFIELD, IL 62702-5303
(217) 545-8000
(217) 757-6519
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036-139989
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036139989001
—
IL
Enumeration date
03/21/2011
Last updated
07/08/2016
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