Individual
VIDYA SRIRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1225 W LAKE ST, MELROSE PARK, IL 60160-4039
(708) 938-7607
Mailing address
PO BOX 2486, INDIANAPOLIS, IN 46206-2486
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036081251
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01621061
BCBS IL
IL
05
—
036081251
—
IL
01
—
36412532002
CHAMPUS
—
01
—
P00032904
RAILROAD MEDICARE
—
Enumeration date
09/16/2006
Last updated
09/08/2009
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