Individual
SRINIVASAN S PURIGHALLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
616 35TH AVE STE 1, MOLINE, IL 61265-6158
(309) 517-3775
(309) 517-3625
Mailing address
616 35TH AVE STE 1, MOLINE, IL 61265-6158
(309) 517-3775
(309) 517-3625
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
036111101
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036111101
—
IN
01
—
5505740001
DMER
IL
01
—
P00136579
MEDICARE RAILROAD
IL
Enumeration date
01/16/2006
Last updated
05/04/2015
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