Basic Information
| Provider Information | |||||||||
| NPI: | 1649566522 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SRINIVAS | ||||||||
| FirstName: | SHEKAR | ||||||||
| MiddleName: | KIKKERI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1516 LOMBARD ST | ||||||||
| Address2: | APT. 2F | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191461667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738203288 | ||||||||
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| Practice Location | |||||||||
| Address1: | 230 N BROAD ST | ||||||||
| Address2: | DEPT OF EMERGENCY MEDICINE | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191021121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157622527 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2011 | ||||||||
| LastUpdateDate: | 06/20/2011 | ||||||||
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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 | 207P00000X | 200462 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.