Provider Demographics
NPI:1093918203
Name:SESHADRI, VENKAT (MD)
Entity Type:Individual
Prefix:
First Name:VENKAT
Middle Name:
Last Name:SESHADRI
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 1:19801 GOVERNORS HWY STE 160
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-4363
Mailing Address - Country:US
Mailing Address - Phone:708-957-0505
Mailing Address - Fax:708-957-0506
Practice Address - Street 1:19801 GOVERNORS HWY STE 160
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-4363
Practice Address - Country:US
Practice Address - Phone:708-957-0505
Practice Address - Fax:708-957-0506
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036133341207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3377004Medicare PIN