Individual
DEVANGI SREEKANTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3800 W 203RD ST, SUITE 204, OLYMPIA FIELDS, IL 60461-1184
(708) 679-2670
(708) 503-3260
Mailing address
1040 SIERRA DR, SUITE 400, GREENWOOD, IN 46143-7240
(317) 528-4253
(317) 865-8319
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036067474
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036067474
—
IL
01
—
203979038
MEDICARE PTAN
IL
01
—
P00006119
RAILROAD
IL
01
—
P00006120
RAILROAD MEDICARE
IL
Enumeration date
04/17/2006
Last updated
11/23/2015
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