Basic Information
| Provider Information | |||||||||
| NPI: | 1558325498 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SREEKANTH | ||||||||
| FirstName: | DEVANGI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 SIERRA DR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461437240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175284253 | ||||||||
| FaxNumber: | 3178658319 | ||||||||
| Practice Location | |||||||||
| Address1: | 3800 W 203RD ST | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | OLYMPIA FIELDS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604611184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086792670 | ||||||||
| FaxNumber: | 7085033260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 11/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 036067474 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | P00006120 | 01 | IL | RAILROAD MEDICARE | OTHER | 203979038 | 01 | IL | MEDICARE PTAN | OTHER | 036067474 | 05 | IL | MEDICAID | P00006119 | 01 | IL | RAILROAD | OTHER |