Provider Demographics
NPI:1508819186
Name:SESHAGIRIRAO, DONTHAMSETTI (MD)
Entity Type:Individual
Prefix:
First Name:DONTHAMSETTI
Middle Name:
Last Name:SESHAGIRIRAO
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 1:146 CIRCLE RIDGE DR
Mailing Address - Street 2:BASEMENT
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-8379
Mailing Address - Country:US
Mailing Address - Phone:312-864-3838
Mailing Address - Fax:312-864-9295
Practice Address - Street 1:2233 W. DIVISION STREET
Practice Address - Street 2:CANCER CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:312-864-3838
Practice Address - Fax:312-864-9295
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360523172085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052317Medicaid
IL036052317Medicaid
ILD88651Medicare UPIN