Individual
VIJAYA SRIPATHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
18209 EULA MAE PKWY, CARLYLE, IL 62231-6407
(812) 238-3800
Mailing address
18209 EULA MAE PKWY, CARLYLE, IL 62231-6407
(812) 238-3800
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
01040974A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100360220
—
IN
Enumeration date
12/06/2006
Last updated
07/17/2013
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