Provider Demographics
NPI:1558316588
Name:CHERUKURI, SREEKANT (MD)
Entity Type:Individual
Prefix:DR
First Name:SREEKANT
Middle Name:
Last Name:CHERUKURI
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 1:389 S SCHMALE RD
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:219-769-5830
Practice Address - Street 1:2210 DEAN ST STE M
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1059
Practice Address - Country:US
Practice Address - Phone:630-668-9610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058090A207Y00000X
IL036118380207Y00000X
IN01058090207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200455040Medicaid
IN200455040Medicaid