Individual
SHYLENDRA B SREENIVASAPPA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5666 EAST STATE STREET, ROCKFORD, IL 61108-2425
(815) 226-2000
Mailing address
5666 EAST STATE STREET, ROCKFORD, IL 61108-2425
(815) 226-2000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-117669
IL
207R00000X
Internal Medicine Physician
36117669
IL
207RH0003X
Hematology & Oncology Physician
036-117669
IL
207RX0202X
Medical Oncology Physician
Primary
036117669
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036117669
—
IL
Enumeration date
06/08/2007
Last updated
01/18/2024
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