Provider Demographics
NPI:1083642672
Name:CHIGURUPATI, SRIDHAR (MD)
Entity Type:Individual
Prefix:MR
First Name:SRIDHAR
Middle Name:
Last Name:CHIGURUPATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KISH HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-9602
Mailing Address - Country:US
Mailing Address - Phone:630-936-4029
Mailing Address - Fax:630-936-4032
Practice Address - Street 1:1 KISH HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9602
Practice Address - Country:US
Practice Address - Phone:630-936-4029
Practice Address - Fax:630-936-4032
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-103927207L00000X
IL036.103927207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103927Medicaid
H47472Medicare UPIN
IL036103927Medicaid