Individual
MADHAV K SRIVASTAVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4920 E STATE ST, ROCKFORD, IL 61108-2272
(815) 226-1906
(815) 226-8474
Mailing address
4920 E STATE ST, ROCKFORD, IL 61108-2272
(815) 226-1906
(815) 226-8474
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
05
—
036061106
—
IL
01
—
791133506
RETIRED RAILROAD
IL
Enumeration date
11/15/2005
Last updated
09/26/2011
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