Provider Demographics
NPI:1609868553
Name:GIRI, VISVANATHA V (MD)
Entity Type:Individual
Prefix:
First Name:VISVANATHA
Middle Name:V
Last Name:GIRI
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 1:903 129TH INFANTRY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3171
Mailing Address - Country:US
Mailing Address - Phone:815-725-2653
Mailing Address - Fax:815-744-3232
Practice Address - Street 1:903 129TH INFANTRY DR
Practice Address - Street 2:SUITE 400
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3171
Practice Address - Country:US
Practice Address - Phone:815-725-2653
Practice Address - Fax:815-744-3232
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-096329174400000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00062390OtherPALMETTO RR MEDICARE
IL036096329Medicaid
IL036096329Medicaid
ILH69890Medicare UPIN
IL206696Medicare ID - Type UnspecifiedWILL COUNTY