Provider Demographics
NPI:1275579401
Name:TATINENI, SUVEER BABU (MD)
Entity Type:Individual
Prefix:DR
First Name:SUVEER
Middle Name:BABU
Last Name:TATINENI
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 1:520 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6110
Mailing Address - Country:US
Mailing Address - Phone:630-874-2542
Mailing Address - Fax:630-874-2642
Practice Address - Street 1:1325 N HIGHLAND AVE
Practice Address - Street 2:PROVENA MERCY MEDICAL CENTER/RADIOLOGY DEPARTMENT
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1449
Practice Address - Country:US
Practice Address - Phone:630-859-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361093052085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0451514334OtherBLUESHIELD PROVIDER#
ILK33815Medicare PIN
IL0451514334OtherBLUESHIELD PROVIDER#
ILI65980Medicare UPIN