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Individual

DR. AMIT K SRIVASTAVA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3722 HARLEM AVE, SUITE 102, RIVERSIDE, IL 60546-2312
(708) 783-7000
(708) 783-7008
Mailing address
3722 HARLEM AVE, SUITE 102, RIVERSIDE, IL 60546-2312
(708) 783-7000
(708) 783-7008

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036071488
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036071488
IL
01
1622295
BCBS #
IL
Enumeration date
06/03/2006
Last updated
04/03/2012
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