Individual
DR. LINE JOHANSEN SRINIVASAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
800 W CENTRAL RD, ARLINGTON HEIGHTS, IL 60005-2349
(847) 618-1000
Mailing address
800 W CENTRAL RD, ARLINGTON HEIGHTS, IL 60005-2349
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036.131163
IL
207L00000X
Anesthesiology Physician
60028-20
WI
207R00000X
Internal Medicine Physician
BP10034486
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780811422
—
WI
Enumeration date
06/21/2009
Last updated
10/11/2014
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