Provider Demographics
NPI:1609297936
Name:SRINIVAS JUJJAVARAPU MD LLC
Entity Type:Organization
Organization Name:SRINIVAS JUJJAVARAPU MD LLC
Other - Org Name:CENTER FOR BLOOD DISORDERS AND CANCER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JUJJAVARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:972-808-7469
Mailing Address - Street 1:4505 N ROCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-3803
Mailing Address - Country:US
Mailing Address - Phone:630-799-9399
Mailing Address - Fax:
Practice Address - Street 1:4505 N ROCKWOOD DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-3803
Practice Address - Country:US
Practice Address - Phone:630-799-9399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095582207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095582OtherLICENSE