Individual
HARINI KOLLURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5841 S MARYLAND AVE, CHICAGO, IL 60637-1447
(773) 795-0168
Mailing address
180 HARVESTER DR STE 110, BURR RIDGE, IL 60527-6686
(773) 795-0168
(773) 702-0443
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01067265A
IN
2080P0205X
Pediatric Endocrinology Physician
036.122918
IL
390200000X
Student in an Organized Health Care Education/Training Program
125051149
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000646342
ANTHEM PIN
IN
01
—
151020NNNN
MEDICARE PTAN
IN
05
—
200965410
—
IN
Enumeration date
07/03/2008
Last updated
04/26/2021
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