Individual
DR. SRECHARAN SHIVA GORUKANTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4400 W 95TH ST STE 306, OAK LAWN, IL 60453-2659
(708) 684-5428
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
036-171652
IL
208100000X
Physical Medicine & Rehabilitation Physician
61158152
WA
Other
Enumeration date
04/01/2020
Last updated
11/05/2024
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