Individual
DR. GOPAL SRINIVASAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 S CALIFORNIA AVE, CHICAGO, IL 60608-1732
(773) 257-6476
Mailing address
3537 PAYSPHERE CIR, CHICAGO, IL 60674-0035
(708) 786-2900
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036-049107
IL
2080N0001X
Neonatal-Perinatal Medicine Physician
036-049107
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-049107-1
—
IL
Enumeration date
08/03/2005
Last updated
05/23/2022
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