Provider Demographics
NPI:1568531564
Name:JOLEPALEM, SRINIVAS-PRASAD REDDY (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVAS-PRASAD
Middle Name:REDDY
Last Name:JOLEPALEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SRINIVAS
Other - Middle Name:R
Other - Last Name:JOLEPALEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8721 CARRIAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-8468
Mailing Address - Country:US
Mailing Address - Phone:630-888-4815
Mailing Address - Fax:630-910-4020
Practice Address - Street 1:8721 CARRIAGE GREEN DR
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-8468
Practice Address - Country:US
Practice Address - Phone:630-888-4815
Practice Address - Fax:630-910-4020
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32848207R00000X, 207RA0401X
IN01064406A207R00000X, 207RA0401X
IL036084786207RA0401X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL8846OtherMEDICARE PTAN#
ILIL8846001OtherMEDICARE PTAN#
ILIL8846001OtherMEDICARE PTAN#