Provider Demographics
NPI:1679758411
Name:CHOLLETI, SRI MADHAVI (MD)
Entity Type:Individual
Prefix:
First Name:SRI MADHAVI
Middle Name:
Last Name:CHOLLETI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SRI MADHAVI
Other - Middle Name:
Other - Last Name:CHOLLETI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5306 N CUMBERLAND AVE
Mailing Address - Street 2:APT 206
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1464
Mailing Address - Country:US
Mailing Address - Phone:408-834-0732
Mailing Address - Fax:
Practice Address - Street 1:5306 N CUMBERLAND AVE
Practice Address - Street 2:APT 206
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1464
Practice Address - Country:US
Practice Address - Phone:408-834-0732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125049071207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine