Provider Demographics
NPI:1689622029
Name:SRIPADA, TERESA LUPA (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LUPA
Last Name:SRIPADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 SOUTH WOOD ST
Mailing Address - Street 2:UNIVERSITY OF ILLINOIS DEPT OF PSYCHIATRY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4300
Mailing Address - Country:US
Mailing Address - Phone:312-355-1221
Mailing Address - Fax:312-413-4915
Practice Address - Street 1:912 S WOOD ST
Practice Address - Street 2:M/C 912
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4300
Practice Address - Country:US
Practice Address - Phone:312-355-1221
Practice Address - Fax:312-413-4915
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036543752084P0005X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C42374Medicare UPIN