Provider Demographics
NPI:1114180643
Name:AYYAGARI, SRIKALA (MD)
Entity Type:Individual
Prefix:
First Name:SRIKALA
Middle Name:
Last Name:AYYAGARI
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 1:8320 SKOKIE BLVD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2545
Mailing Address - Country:US
Mailing Address - Phone:847-410-6501
Mailing Address - Fax:
Practice Address - Street 1:8320 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2545
Practice Address - Country:US
Practice Address - Phone:847-410-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036145827207R00000X
CAA118048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFJ753YMedicare Oscar/Certification