Provider Demographics
NPI:1689839532
Name:KUSUMA, SRINIVASU (MD)
Entity Type:Individual
Prefix:DR
First Name:SRINIVASU
Middle Name:
Last Name:KUSUMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SRINU
Other - Middle Name:
Other - Last Name:KUSUMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:27702 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1277
Mailing Address - Country:US
Mailing Address - Phone:708-862-7674
Mailing Address - Fax:708-682-1781
Practice Address - Street 1:1600 167TH ST STE 900
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5407
Practice Address - Country:US
Practice Address - Phone:708-647-7565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.135648207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery