Organization
DRS. SRIVASTAVA S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN ECKHARDT (PRACTICE ADMINISTRATOR)
(815) 226-1906
Entity
Organization
Contact information
Practice address
5668 E STATE ST, SUITE 2700, ROCKFORD, IL 61108-2490
(815) 226-1906
Mailing address
5668 E STATE ST, SUITE 2700, ROCKFORD, IL 61108-2490
(815) 226-1906
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
36061106
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010100569
BCBS
IL
01
—
008839
HEALTH ALLIANCE
IL
Enumeration date
01/18/2007
Last updated
08/22/2020
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