Individual
DR. KRISHNAN SRINIVASAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3981
(217) 366-1299
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3981
(217) 366-1299
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
036-084652
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-084-652
—
IL
01
—
1770579922
NPI
—
01
—
F400112794
MEDICARE PTAN
IL
Enumeration date
09/23/2005
Last updated
03/29/2023
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