Provider Demographics
NPI:1073942264
Name:TIPIRNENI, PADMA (MD)
Entity Type:Individual
Prefix:DR
First Name:PADMA
Middle Name:
Last Name:TIPIRNENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17608 SAN BERNARDINO DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8210
Mailing Address - Country:US
Mailing Address - Phone:650-704-7523
Mailing Address - Fax:
Practice Address - Street 1:17608 SAN BERNARDINO DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8210
Practice Address - Country:US
Practice Address - Phone:650-704-7523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036 046374207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy