Provider Demographics
NPI:1598919755
Name:DRS SRIPADA MD SC
Entity Type:Organization
Organization Name:DRS SRIPADA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIPADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-835-9085
Mailing Address - Street 1:361 PARK AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1587
Mailing Address - Country:US
Mailing Address - Phone:847-835-9085
Mailing Address - Fax:
Practice Address - Street 1:361 PARK AVE
Practice Address - Street 2:STE 202
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-1587
Practice Address - Country:US
Practice Address - Phone:847-835-9085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL360543752084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty